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Provider Information for 1306834783

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MR. CHRISTOPHER P KELLY PA

Gender: MALE

Individual NPI: 1306834783

Calendar   Last Updated:  2018-06-06
  Certification Date: 

Details

Name Value
NPI 1306834783
Enumeration Date 2005-10-11
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 703 VIRGINIA ST
DUNEDIN, FL 34698-6615
United States

Phone: 727-734-4000 | Fax: 727-738-5037
View Map External Link
Primary Practice Address 703 VIRGINIA ST
DUNEDIN, FL 34698
United States

Phone: 727-734-4000 | Fax: 727-738-5037
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 291709200
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363A00000X - Physician Assistant FL PA9101046