MEDICARE: VANESSA KELLY

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	124Q00000X	Dental Hygienist	DH25888	FL

General Provider Information

NPI Number	:	1447919386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA KELLY

Provider Business Mailing Address
First Line	:	6265 OLD WATER OAK RD UNIT 203
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-4155
Country	:	US
Telephone Number	:	850-408-7326
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 OLD WATER OAK RD UNIT 203
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-4155
Country	:	US
Telephone Number	:	850-408-7326
Fax Number	:

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

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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Directions to “ VANESSA KELLY ” Practice Location

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