Healthcare Provider Details

I. General information

NPI: 1811979461
Provider Name (Legal Business Name): KELLI A CROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 CENTRAL AVE
ST PETERSBURG FL
33710-8240
US

IV. Provider business mailing address

5033 CENTRAL AVE
ST PETERSBURG FL
33710-8240
US

V. Phone/Fax

Practice location:
  • Phone: 727-334-8523
  • Fax: 727-292-1164
Mailing address:
  • Phone: 727-334-8523
  • Fax: 727-292-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0071388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: