MEDICARE: KELLY ANDERSON MLS

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	246QL0900X	Laboratory Management Specialist/Technologist	SU44843	FL

General Provider Information

NPI Number	:	1881526374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANDERSON MLS

Provider Business Mailing Address
First Line	:	14619 NW 21ST PL
Second Line	:
City	:	NEWBERRY
State	:	FL
Zip	:	32669-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4039 NEWBERRY RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2342
Country	:	US
Telephone Number	:	352-224-1600
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ KELLY ANDERSON MLS” Practice Location

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