Provider Demographics
NPI:1720322936
Name:KELLEY, LOUISE ELIZABETH (MS, RN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ELIZABETH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4548
Mailing Address - Country:US
Mailing Address - Phone:727-586-0138
Mailing Address - Fax:
Practice Address - Street 1:5040 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0511
Practice Address - Country:US
Practice Address - Phone:863-859-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9307372363LF0000X
NYF332248-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily