MEDICARE: KELLY ALDRED FNP-C

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	APRN11045933	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1063571982	OTHER	FL	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245418979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ALDRED FNP-C

Provider Business Mailing Address
First Line	:	15255 MAX LEGGETT PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7273
Country	:	US
Telephone Number	:	904-383-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	15255 MAX LEGGETT PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7273
Country	:	US
Telephone Number	:	904-383-1000
Fax Number	:

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	03/26/2026

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