MEDICARE: MS. KATHLEEN ANDREA MCCARVELL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP60785852	WA
2	363L00000X	Nurse Practitioner	003604	CT

General Provider Information

NPI Number	:	1154500981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANDREA MCCARVELL APRN

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1400
Fax Number	:	239-424-1421

Provider Business Practice Location Address
First Line	:	12550 NEW BRITTANY BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5968
Country	:	US
Telephone Number	:	239-936-1114
Fax Number	:	239-936-5968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	01/09/2020

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