Individual provider Active NPI

Kelly Burr, ARNP

  • Pediatric Nurse Practitioner
  • Largo, FL
National Provider Identifier
1861797763
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP9171603 Issued in FL
Practice address
12170 Seminole Blvd
Largo, FL 33778-2833
Phone
(727) 586-5355
Fax
(727) 526-4346
NPI assigned
Jan 24, 2011
Last updated
Sep 7, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X ARNP9171603 FL Primary

Addresses

Primary practice location

12170 Seminole Blvd
Largo, FL 33778-2833

Mailing address

4278 28TH St N
St Petersburg, FL 33714-3922
Phone (727) 526-9135

Other identifiers 1

IdentifierTypeStateIssuer
003097100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ARNP9171603FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mariano D Cibran, MD Corp Dba St Petersburg Pediatrics Pediatrics Past Accepting new patients
Mariano D Cibran, MD Corp Dba St Petersburg Pediatrics PastSince Jun 22, 2021 Accepting new patients
Well Health Works Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1861797763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4278 28TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337143922",
            "telephone_number": "727-526-9135",
            "fax_number": "727-526-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12170 SEMINOLE BLVD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337782833",
            "telephone_number": "727-586-5355",
            "fax_number": "727-526-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURR",
        "first_name": "KELLY",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP9171603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003097100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.