Individual provider Active NPI

Kelli Kraaz, ARNP- FNP

  • Family Nurse Practitioner
  • Fort Pierce, FL
National Provider Identifier
1003275157
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN 2165662 Issued in FL
Practice address
3307 N Indian River Dr
Fort Pierce, FL 34946-8418
Phone
(772) 528-5991
NPI assigned
Feb 17, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN2165662 FL
Family Nurse Practitioner 363LF0000X RN 2165662 FL Primary

Addresses

Primary practice location

3307 N Indian River Dr
Fort Pierce, FL 34946-8418

Mailing address

3307 N Indian River Dr
Fort Pierce, FL 34946-8418
Phone (772) 528-5991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181001001581 FL Practitioner - Nurse Practitioner 0648521666 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3307 N Indian River Dr
Fort Pierce, FL 34946-8418
Phone (772) 528-5991

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN2165662FLMDFamily Nurse Practitioner
RN 2165662FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Impact Practitioner Services, LLC CurrentSince Mar 11, 2024 Accepting new patients
Internal Medicine Consultants of Saint Lucie County LLC CurrentSince Feb 23, 2019 Accepting new patients
Humayun Shareef MD PA CurrentSince Aug 8, 2018 Accepting new patients

Locations

2401 Frist Blvd
Ste 1
Fort Pierce, FL 34950
Phone (772) 464-0033

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FJJBCA

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1003275157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3307 N INDIAN RIVER DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349468418",
            "telephone_number": "772-528-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 N INDIAN RIVER DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349468418",
            "telephone_number": "772-528-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAAZ",
        "first_name": "KELLI",
        "name_prefix": "Ms.",
        "credential": "ARNP- FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-17",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN2165662",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "RN 2165662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.