Healthcare Provider Details

I. General information

NPI: 1134066632
Provider Name (Legal Business Name): KELLYS FAMILY HEALTHCARE NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BRESKI LN
HALFMOON NY
12065-6202
US

IV. Provider business mailing address

5 BRESKI LN
HALFMOON NY
12065-6202
US

V. Phone/Fax

Practice location:
  • Phone: 321-946-6552
  • Fax:
Mailing address:
  • Phone: 321-946-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUZ M KELLY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 321-946-6552