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NPI Code Detail

MEDICARE: KELLY ANN ROOT

MEDICARE: KELLY ANN ROOT
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
1103K00000XBehavior Analyst1-25-79263FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720662596
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANN ROOT
Provider Business Mailing Address
First Line : 745 ORIENTA AVE STE 1011
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32701-5675
Country : US
Telephone Number : 877-823-4283
Fax Number :
Provider Business Practice Location Address
First Line : 50 S BELCHER RD STE 103
Second Line :
City : CLEARWATER
State : FL
Zip : 33765-3948
Country : US
Telephone Number : 877-823-4283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2021
Last Update Date : 04/25/2025

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Directions to “ KELLY ANN ROOT ” Practice Location

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