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NPI Code Detail

MEDICARE: DR. KRISTEN KELLEY PSYD

MEDICARE: DR. KRISTEN KELLEY PSYD
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
1103TC0700XClinical PsychologistPY8745FL
2103TC0700XClinical PsychologistPSY20211CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154483956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN KELLEY PSYD
Provider Business Mailing Address
First Line : PO BOX 748519
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8519
Country : US
Telephone Number : 904-376-3800
Fax Number : 904-376-3998
Provider Business Practice Location Address
First Line : 98 NOCATEE VILLAGE DR
Second Line :
City : PONTE VEDRA BEACH
State : FL
Zip : 32081-6152
Country : US
Telephone Number : 904-376-3800
Fax Number : 904-390-7392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 09/11/2025

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