Provider Demographics
NPI:1790532885
Name:WELDON, KELLY LAYTON (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LAYTON
Last Name:WELDON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LAYTON
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:455 PHILIP BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8768
Mailing Address - Country:US
Mailing Address - Phone:770-962-3642
Mailing Address - Fax:770-962-3643
Practice Address - Street 1:36474 EMERALD COAST PKWY STE C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4711
Practice Address - Country:US
Practice Address - Phone:404-852-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278261363LF0000X
FLAPRN11039540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty