Tashiana Kelly

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

W689477 Issued in FL

Practice address

2611 University Blvd N Apt C203
Jacksonville, FL 32211-3287

Phone

(904) 248-2208

NPI assigned

Oct 15, 2020

Last updated

Oct 15, 2020By 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

Other identifiers 1

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": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1528666146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 UNIVERSITY BLVD N APT C203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322113287",
            "telephone_number": "904-248-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 UNIVERSITY BLVD N APT C203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322113287",
            "telephone_number": "904-248-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TASHIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "FL",
            "license": "W689477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE IDENTIFICATION",
            "identifier": "K400801859330",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Anne Kelly, MD
• Neidy Hernandez Kelly, MA, NCC, LPC, LMHC
• Nicholas Joseph Kelly, MD
• Patrick Kelly, M.D.
• Stacey Ann Kelly, APRN
• Alan Robert Kelm
• Angelique Kelsey
• Alan Kelso, HAS
• Lorna Ann Kelso, APRN
• Anthony William Kemmer, DO

• Point of Service in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Point of Service in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.