Healthcare Provider Details

I. General information

NPI: 1083492250
Provider Name (Legal Business Name): MADISON KELLY MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MIAMI AVE
MIAMI FL
33130-4100
US

IV. Provider business mailing address

1250 S MIAMI AVE
MIAMI FL
33130-4100
US

V. Phone/Fax

Practice location:
  • Phone: 305-571-6250
  • Fax:
Mailing address:
  • Phone: 305-571-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11028715
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: