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General NPI Number Information
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NPI Number | 1104442722
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Entity Type | Individual
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Provider Name | KELLEY DOWNS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 01/07/2023
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Provider Practice Location Address
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Address Line | 9857 OLD SAINT AUGUSTINE RD STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8821
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Country | US
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Telephone | 904-853-9068
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Fax |
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Provider Business Mailing Address
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Address Line | 11032 BUGGY WHIP DR
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City | JACKSONVILLE
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State | FL
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Zip | 32257-3639
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Country | US
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Telephone | 419-205-6686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN24881
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN24881
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License Number State | FL
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