Eileen Kelly, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

ARNP2778312 Issued in FL

Practice address

1403 Medical Plaza Dr
Suite 202
Sanford, FL 32771-1000

Phone

(407) 322-3096

Fax

(407) 321-5655

NPI assigned

Oct 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Adly Thebaud,MD,PA

  dba Family Psychiatry Services

  • Community/Behavioral Health Agency
  • Orange City, FL
  • NPI 1417018482

  Psychiatric/Mental Health

  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285729442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 MEDICAL PLAZA DR",
            "address_2": "SUITE 202",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711000",
            "telephone_number": "407-322-3096",
            "fax_number": "407-321-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 MEDICAL PLAZA DR",
            "address_2": "SUITE 202",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711000",
            "telephone_number": "407-322-3096",
            "fax_number": "407-321-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "EILEEN",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP2778312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KB Eyecare Inc.
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• Tamara Kelly Brown, RPH
• Katherine Elizabeth Kersjes
• Kids House of Seminole
• Kids House of Seminole, Inc.
• Kim-S Acupuncture Clinic Inc. (Sage Wellness Center)
• Eileen E Kim, PA-C

• Psychiatric/Mental Health Nurse Practitioner in Sanford, FL
• Providers in Sanford, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.