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NPI Code Detail

MEDICARE: JORDAN KELLEY

MEDICARE: JORDAN KELLEY
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1891632592
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN KELLEY
Provider Business Mailing Address
First Line : 4401 N HIMES AVE STE 175
Second Line :
City : TAMPA
State : FL
Zip : 33614-7095
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 N HIMES AVE STE 175
Second Line :
City : TAMPA
State : FL
Zip : 33614-7095
Country : US
Telephone Number : 717-917-1978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2026
Last Update Date : 04/30/2026

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Directions to “ JORDAN KELLEY ” Practice Location

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