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NPI Code Detail

MEDICARE: MRS. KELLY MCCULLOUGH ARNP

MEDICARE: MRS. KELLY MCCULLOUGH ARNP
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
1363L00000XNurse PractitionerARNP2752232FL

General Provider Information

NPI Number : 1285627273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY MCCULLOUGH ARNP
Provider Business Mailing Address
First Line : 7227 LAND O LAKES BLVD
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-2826
Country : US
Telephone Number : 727-774-2360
Fax Number : 813-794-2120
Provider Business Practice Location Address
First Line : 7227 LAND O LAKES BLVD
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-2826
Country : US
Telephone Number : 727-774-2360
Fax Number : 813-794-2120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 07/08/2007

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