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NPI Code Detail

MEDICARE: MRS. KELLY JEAN MACKEY APRN

MEDICARE: MRS. KELLY JEAN MACKEY APRN
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
1363LF0000XFamily Nurse PractitionerAPRN11004725FL

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 : 1386287217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY JEAN MACKEY APRN
Provider Business Mailing Address
First Line : 7727 LAKE UNDERHILL RD
Second Line :
City : ORLANDO
State : FL
Zip : 32822-8224
Country : US
Telephone Number : 407-821-3508
Fax Number :
Provider Business Practice Location Address
First Line : 7727 LAKE UNDERHILL RD
Second Line :
City : ORLANDO
State : FL
Zip : 32822-8224
Country : US
Telephone Number : 407-821-3508
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 01/22/2026

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