MEDICARE: DR. FRANCIS DONALD KELLY JR. PH.D.

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	103T00000X	Psychologist	PY 2340	FL

General Provider Information

NPI Number	:	1649310558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCIS DONALD KELLY JR. PH.D.

Provider Business Mailing Address
First Line	:	2018 FOREST GLEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-5100
Country	:	US
Telephone Number	:	850-386-2316
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 DELTA CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-4875
Country	:	US
Telephone Number	:	850-385-8847
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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