MEDICARE: KELSIE KROLL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11032998	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	37563	TN

General Provider Information

NPI Number	:	1558104588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE KROLL

Provider Business Mailing Address
First Line	:	106 DUNCAN TRL
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-4511
Country	:	US
Telephone Number	:	407-620-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 PATTERSON ST STE 210
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1553
Country	:	US
Telephone Number	:	615-457-8585
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	11/22/2024

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Directions to “ KELSIE KROLL ” Practice Location

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