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NPI Code Detail

MEDICARE: EMILY KELLUM

MEDICARE: EMILY KELLUM
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11043512FL

General Provider Information

NPI Number : 1275403974
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY KELLUM
Provider Business Mailing Address
First Line : 1700 EDUCATION AVE
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33950-6222
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 EDUCATION AVE
Second Line :
City : PUNTA GORDA
State : FL
Zip : 33950-6222
Country : US
Telephone Number : 941-639-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2025
Last Update Date : 04/08/2026

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Directions to “ EMILY KELLUM ” Practice Location

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