Healthcare Provider Details

I. General information

NPI: 1285627273
Provider Name (Legal Business Name): KELLY MCCULLOUGH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 RIDGE RD STE 302
PORT RICHEY FL
34668-6867
US

IV. Provider business mailing address

7227 LAND O LAKES BLVD
LAND O LAKES FL
34638-2826
US

V. Phone/Fax

Practice location:
  • Phone: 727-478-8876
  • Fax: 877-487-5705
Mailing address:
  • Phone: 727-774-2360
  • Fax: 813-794-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2752232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: