Kelly Leedy Jennings – Family Nurse Practitioner

Key facts

NPI: 1992120141
Entity type: Individual (NPI type 1)
Primary specialty: Family Nurse Practitioner 363LF0000X
License: LG-0000737 (DE)
Practice address: 303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709
Phone: (386) 425-4000
NPI assigned: Feb 25, 2014
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Halifax Healthcare Systems Inc Family Medicine Physician · Daytona Beach, FL · NPI 1245283530

Medicare reassignment Care Compare group NPD FL

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Halifax Hospital Medical Center General Acute Care Hospital · Daytona Beach, FL · NPI 1811991227

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2013
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Halifax Healthcare Systems Inc (345 clinicians)

Practice addresses (Care Compare)

303 N Clyde Morris Blvd
First Floor East
Daytona Beach, FL 32114-2709
Phone (386) 425-6198

Hospital & facility affiliations

Halifax Health Medical Center Hospital · Daytona Beach, FL · CCN 100017

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20170617000241	FL	Practitioner - Nurse Practitioner	5193944478	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

Practice roles (1 of 2)

Organization	Specialty	Status	New patients
Halifax Healthcare Systems Inc		Current since May 1, 2017	Accepting new patients

Locations

303 N Clyde Morris Blvd
Fl First
Daytona Beach, FL 32114
Phone (386) 425-6198

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

1041 Dunlawton Ave
Pt Orange, FL 32127
Phone (386) 322-4700

Networks

Freedom Health HMO Network

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Nurse Practitioner	363LF0000X	LG-0000737	DE	Yes

Addresses

Primary practice location

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709

Mailing address

701 N Clayton St
Wilmington, DE 19805-3165
Phone (302) 421-4334

Other practice location 1

701 N Clayton St
Wilmington, DE 19805-3165
Phone (302) 421-4334

Other names

Kelly Nichols Leedy Former name

Other providers in Daytona Beach, FL

All providers in Daytona Beach, FL · Family Nurse Practitioner in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.