Provider Demographics
NPI:1750986956
Name:SMALL, KELSEY (APRN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7454 RIVERBANK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2634
Mailing Address - Country:US
Mailing Address - Phone:727-207-3556
Mailing Address - Fax:
Practice Address - Street 1:2202 DUCK SLOUGH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5071
Practice Address - Country:US
Practice Address - Phone:727-203-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452892163W00000X
FLAPRN11023055363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9452892Other163W00000X