MEDICARE: KELLY LIANG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11031910	FL

General Provider Information

NPI Number	:	1013771922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LIANG NP

Provider Business Mailing Address
First Line	:	3450 LANTANA RD STE 100
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-1304
Country	:	US
Telephone Number	:	561-965-1864
Fax Number	:	561-967-5005

Provider Business Practice Location Address
First Line	:	3450 LANTANA RD STE 100
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-1304
Country	:	US
Telephone Number	:	561-965-1864
Fax Number	:	561-967-5005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	11/21/2025

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Directions to “ KELLY LIANG NP” Practice Location

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