Kelly Nicole Willett

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME151374 Issued in FL

Practice address

705 Riley Hospital Dr RM 5867
Indianapolis, IN 46202-5109

Phone

(317) 944-4034

NPI assigned

Apr 11, 2018

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

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Tampa Family Health Centers Inc

  • Multi-Specialty Clinic/Center
  • Tampa, FL
  • NPI 1356347413
  Medicare reassignment NPD
• Tampa Family Health Centers, Inc

  • General Practice Physician
  • Tampa, FL
  • NPI 1831769579
  NPD
• Tampa Family Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Tampa, FL
  • NPI 1891251336
  NPD
• University Pediatric Associates, Inc.

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1457396541
  NPD (past)

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1780181214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 E BEARSS AVE",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335493525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 RILEY HOSPITAL DR RM 5867",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025109",
            "telephone_number": "317-944-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLETT",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME151374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Willard, LAT, ATC
• Claire Alanna Willard, MD
• Anne M Willet, FNP
• Britany Nicole Willett, NP
• Heather Rae Willett, PA
• Elisha Willetts
• Lisa Anne Willey, COTA
• Courtney Willford
• Macie L Willhite, AU.D.
• William C. Tellman, DDS, PC

• Pediatrics Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.