Provider Demographics
NPI:1285437327
Name:KELLY, KAYLAN ALYSSA (DO)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:ALYSSA
Last Name:KELLY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SUTTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-9614
Mailing Address - Country:US
Mailing Address - Phone:813-352-0854
Mailing Address - Fax:
Practice Address - Street 1:3013 SUTTON WOODS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-9614
Practice Address - Country:US
Practice Address - Phone:813-352-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program