=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427228147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL L KELLEY R.N.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 03/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 BAY PINES BLVD BAY PINES VETERANS HOSPITAL
-----------------------------------------------------
City | BAY PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-6661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8742 52ND AVE E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34211-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-755-5068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 85850-2
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------