COREEN KELLY
NPI 1790319994
Nurse Practitioner in Daytona Beach, FL

Q: What is Coreen Kelly's NPI number?

The NPI number for Coreen Kelly is 1790319994. It was assigned to this individual provider in the NPPES registry on February 26, 2020.

Q: What is Coreen Kelly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Coreen Kelly was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 26, 2020PECOS EnrolledAccepts Medicare Assignment

1430 MASON AVE, DAYTONA BEACH, FL 32117(386) 274-2000(386) 274-2009 Get Directions Write a Review

NPPES record last updated: November 19, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 19, 2024, Feb 26, 2020 (2 updates tracked since 2020).

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About Coreen Kelly NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COREEN KELLY (NPI 1790319994) is an individual nurse practitioner in Daytona Beach, Florida, licensed in Florida (APRN11006345) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1790319994

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameCOREEN KELLY

Location Address1430 MASON AVEDaytona Beach, FL 32117-4551

Mailing Address1862 Silver Fern RdPort Orange, FL 32128-6741 · (518) 409-3502

Phone(386) 274-2000

Fax(386) 274-2009

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateFebruary 26, 2020

Last NPPES UpdateNovember 19, 20242 updates tracked since enumeration

NPPES CertifiedNovember 19, 2024

✔ NPI 1790319994 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in FL · APRN11006345

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1430 MASON AVE, Daytona Beach, FL 32117

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Coreen Kelly is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4082090238

PECOS Enrollment IDI20220926003034

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

477 services123 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

12 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32117 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RICHARD MITCHEL FUENTES DPT

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