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General NPI Number Information
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NPI Number | 1538399738
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Entity Type | Individual
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Provider Name | JASON STUART KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 1250 S 18TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1902
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Country | US
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Telephone | 904-261-6221
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Fax |
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Provider Business Mailing Address
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Address Line | 478 CROSSWIND DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-2778
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Country | US
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Telephone | 904-261-6221
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 252864
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME107561
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License Number State | FL
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