John Kelly

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3217 Issued in FL

Practice address

4550 Lantana Road
Suite A4
Lake Worth, FL 33463

Phone

(561) 340-7259

NPI assigned

Dec 27, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jack Kelly Other name

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": "1324944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1508135252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9170 SW 14TH ST APT 4107",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334286829",
            "telephone_number": "561-603-1807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 LANTANA ROAD",
            "address_2": "SUITE A4",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33463",
            "telephone_number": "561-340-7259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "3217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "KELLY",
            "credential": "CAP,NLP,LHP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nancy Rochelle Keit, PT
• Alex David Keith, DC CCSP
• Tommy Lewis Kellar
• Alexis Kelly, DNP
• Claudine Kelly, LMHC
• Julie Kelly, ARNP
• Sean Kelly, RN
• Kendall Kemp
• Kennedy Health Care, Inc.
• Angela Kennedy

• Addiction (Substance Use Disorder) Counselor in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Addiction (Substance Use Disorder) Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; 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.