Amy Jo Kelly

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F04210218 Issued in FL

Practice address

1790 Hideaway LN
Edgewater, FL 32132-2913

Phone

(386) 689-0586

NPI assigned

Apr 7, 2021

Last updated

Apr 7, 2021By 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

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": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1922687664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W 1ST ST STE 236",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 HIDEAWAY LN",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "321322913",
            "telephone_number": "386-689-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "AMY",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "F04210218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Impact Therapy & Wellness LLC
• Intercoastal Orthotics & Prosthetics, LLC
• Iq Academy. Inc
• Michael Eugene Johnson, M.D.
• K Ville LLC (Mindful Healing)
• Tina Kendrick
• Charles Edward Kollmer, MD
• Kelly Koons, RD, CDE, LD
• Orest Michael Krajnyk, MD
• L S Superior Billing,LLC

• Family Nurse Practitioner in Edgewater, FL
• Providers in Edgewater, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.