Healthcare Provider Details

I. General information

NPI: 1487465852
Provider Name (Legal Business Name): MR. DAVID KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HASE RD
PENSACOLA FL
32508-1051
US

IV. Provider business mailing address

7474 DECK LN
PENSACOLA FL
32526-8593
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4212
  • Fax:
Mailing address:
  • Phone: 850-512-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT564404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: