Jacklyn Kelly

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH24162 Issued in FL

Practice address

10014 N Dale Mabry Hwy Ste 202
Tampa, FL 33618-4426

Phone

(813) 609-2721

NPI assigned

Jul 17, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1386482008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10014 N DALE MABRY HWY STE 202",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336184426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10014 N DALE MABRY HWY STE 202",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336184426",
            "telephone_number": "813-609-2721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Hudson St Fl 9",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100131810",
            "country_code": "US",
            "telephone_number": "646-941-7645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACKLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "014918",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH24162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Dee Kelly, PHD
• Celine Mary Kelly, PT
• Christopher Kelly, PT
• Elaine Clair Kelly, LCSW
• Erin E Kelly, OTR/L
• Karen Lynn Kelly, R.N.
• Kathryn Marie Couture Kelly, MD
• Mark Edward Kelly, MD
• Pamela S Kelly, ARNP
• Parker T Kelly, DPT

• Mental Health Counselor in Tampa, FL
• Providers in Tampa, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.