Coreen Kelly

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11006345 Issued in FL

Practice address

1430 Mason Ave
Daytona Beach, FL 32117-4551

Phone

(386) 274-2000

Fax

(386) 274-2009

NPI assigned

Feb 26, 2020

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dna Center LLCGroup PAC ID 7618108978, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: dnacenter.coreenkelly@156696.advancedmd-direct.com
• FHIR API: https://api.platform.athenahealth.com/11878/brand/3/csg/1/fhir/r4

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.

• Dna Center LLC

  dba Pain and Spine Specialists of Florida

  • Multi-Specialty Clinic/Center
  • Daytona Beach, FL
  • NPI 1609117647
  Medicare reassignment Care Compare group NPD
• Pain and Spine Specialists of Maryland, LLC

  dba Pain and Spine Specialists of Florida

  • Specialist
  • Mount Airy, MD
  • NPI 1174884258

  FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1790319994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1862 SILVER FERN RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286741",
            "telephone_number": "518-409-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174551",
            "telephone_number": "386-274-2000",
            "fax_number": "386-274-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "COREEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-26",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11006345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nelson Kazie, MD
• Peter Keirstead, L.M.H.C
• Kathy Keith
• Corrina Kelch, ARNP
• Kelly Cares Inc
• Daniel William Kelly, PA-C
• Elizabeth Victoria Kelly, PA STUDENT
• Shawn Demian Kelly, APRN
• Robert Kemp, LMHC
• Kemshol Medical Center PA

• Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.