Provider Demographics
NPI:1629574637
Name:KELLY, WILLIAM JAMES (FNP-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:KELLY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 SAND ARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4761
Mailing Address - Country:US
Mailing Address - Phone:407-565-9597
Mailing Address - Fax:407-550-3923
Practice Address - Street 1:525 ROUTE 73 N STE 117
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3422
Practice Address - Country:US
Practice Address - Phone:407-565-9597
Practice Address - Fax:407-550-3923
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64528363L00000X
FL11014255363LF0000X
AZ262907363LF0000X
NJ26NJ00812800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily