MEDICARE: CASSIANNE 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	146M00000X	Intermediate Emergency Medical Technician

General Provider Information

NPI Number	:	1649113838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIANNE KELLY

Provider Business Mailing Address
First Line	:	105 UTLEY BLUFFS DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BURLINGTON DR
Second Line	:
City	:	CLARKSVILLE
State	:	VA
Zip	:	23927-3235
Country	:	US
Telephone Number	:	434-738-0028
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ CASSIANNE KELLY ” Practice Location

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