MEDICARE: KAECYN BEHAVIORAL HEALTH SERVICES LLC

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

General Provider Information

NPI Number	:	1558230664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAECYN BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	10131 FOX LAKE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1693
Country	:	US
Telephone Number	:	904-525-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	10131 FOX LAKE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1693
Country	:	US
Telephone Number	:	904-525-0418
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAMEILA YONNIQUE KELLY
Credential	:	PMHNP
Telephone Number	:	904-525-0418

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	01/06/2026

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