Healthcare Provider Details

I. General information

NPI: 1659831444
Provider Name (Legal Business Name): RACHEL KELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL OLDHAM

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 US HIGHWAY 1 STE 101
ROCKLEDGE FL
32955-3763
US

IV. Provider business mailing address

325 MELTON CT
ROCKLEDGE FL
32955-4774
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-0005
  • Fax: 321-636-9030
Mailing address:
  • Phone: 321-636-0005
  • Fax: 321-636-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11037636
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9698759
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13394
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.13394
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.341247
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: