Judith Ann Killeen, ARNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

ARNP1791762 Issued in FL

Practice address

1127 16TH Ave S
Jacksonville Beach, FL 32250

Phone

(904) 247-7778

Fax

(904) 247-9461

NPI assigned

Mar 4, 2006

Last updated

Dec 28, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1141430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545955200000",
    "number": "1427025790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45443",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841450443",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 16TH AVE S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "32250",
            "telephone_number": "904-247-7778",
            "fax_number": "904-247-9461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1127 16th Ave S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville Beach",
            "state": "FL",
            "postal_code": "32250",
            "country_code": "US",
            "telephone_number": "904-247-7778",
            "fax_number": "904-247-9461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILLEEN",
        "first_name": "JUDITH",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-04",
        "last_updated": "2018-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP1791762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "34436",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abby Rae Kelly
• Vanessa Kelly, LMT
• Michael H Kessler, D.D.S.
• Ketamine Wellness Institute of Jacksonville Beach, LLC
• Lisa Kidd, NP
• Aaron Kindsvatter, PH.D. LMHC
• Maxwell Clark King II, B.PH.
• Anneline Kingsley, M.D.
• Courtney Kirkham, COTA
• Donny Klay, APRN

• Adult Health Nurse Practitioner in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; 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.