Kelli Kristiana Grady, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

11001066 Issued in FL

Practice address

4880 N Highway 19a Ste 200
Mount Dora, FL 32757-2018

Phone

(352) 589-8111

NPI assigned

May 17, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lake Pediatrics P. a.

  • Rural Health Clinic/Center
  • Mount Dora, FL
  • NPI 1942367370
  NPD (past)

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

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1922664762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 TOURNAMENT DR",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327122022",
            "telephone_number": "813-230-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 N HIGHWAY 19A STE 200",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572018",
            "telephone_number": "352-589-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "KELLI",
        "middle_name": "KRISTIANA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-17",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "11001066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Golden Mind Psychiatric, PLLC
• Kelia Gomez
• Ketchma Gomez
• Vicmary Gonzalez Ortega, RBT
• Good Care & Wellness LLC (Relieve - Pain and Spine Center)
• Cordalius Graham
• Cornelia Graham, RBT
• Ivette-Marie Grasser
• Wesley Green
• Jeffrey S. Greenwald, M.D.

• Pediatric Nurse Practitioner in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Pediatric Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.