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General NPI Number Information
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NPI Number | 1710601828
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Entity Type | Individual
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Provider Name | KELLY RYAN HOLBERT FNP-BC, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 6641 MADISON ST STE 3
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1966
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Country | US
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Telephone | 727-203-4417
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Fax | 727-203-4427
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Provider Business Mailing Address
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Address Line | 19907 WYNDMILL CIR
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City | ODESSA
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State | FL
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Zip | 33556-1731
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Country | US
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Telephone | 813-728-4414
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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 | APRN11020555
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License Number State | FL
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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 | APRN11020555
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License Number State | FL
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