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
1	363L00000X	Nurse Practitioner	ARNP2752232	FL

Other Identifiers

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

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	:	6709 RIDGE RD STE 302
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6867
Country	:	US
Telephone Number	:	727-478-8876
Fax Number	:	877-487-5705

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	05/12/2026

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