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General NPI Number Information
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NPI Number | 1194416685
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Entity Type | Individual
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Provider Name | NEIDY HERNANDEZ KELLY MA, NCC, LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 7825 BAYMEADOWS WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7557
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Country | US
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Telephone | 904-717-2340
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Fax | 904-717-2340
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Provider Business Mailing Address
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Address Line | 4320 DEERWOOD LAKE PKWY STE 101-422
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1177
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Country | US
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Telephone | 904-717-2340
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Fax | 904-717-2340
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8368
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11544
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH26887
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License Number State | FL
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