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General NPI Number Information
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NPI Number | 1629574637
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Entity Type | Individual
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Provider Name | WILLIAM JAMES KELLY FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 N STE 117
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | 407-565-9597
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Fax | 407-550-3923
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Provider Business Mailing Address
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Address Line | 2725 SAND ARBOR CIR
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City | ORLANDO
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State | FL
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Zip | 32824-4761
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Country | US
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Telephone | 407-565-9597
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Fax | 407-550-3923
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 64528
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11014255
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 262907
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00812800
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License Number State | NJ
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