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General NPI Number Information
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NPI Number | 1811188618
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Entity Type | Individual
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Provider Name | KRISTIN LUEBBERT KELLY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1255 37TH ST SUITE C
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City | VERO BEACH
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State | FL
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Zip | 32960-6550
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Country | US
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Telephone | 772-564-2485
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Fax | 772-564-6132
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Provider Business Mailing Address
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Address Line | 1255 37TH ST SUITE C
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City | VERO BEACH
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State | FL
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Zip | 32960-6550
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Country | US
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Telephone | 772-564-2485
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Fax | 772-564-6132
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0092614
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License Number State | FL
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