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General NPI Number Information
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NPI Number | 1568190221
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Entity Type | Individual
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Provider Name | MADELEINE RAE KELLEY APRN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 103 SE 3RD ST
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City | TRENTON
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State | FL
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Zip | 32693-3247
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Country | US
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Telephone | 352-577-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 459 SE HERNANDO AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-5977
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Country | US
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Telephone | 352-356-3037
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11021350
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License Number State | FL
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