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NPI Code Detail

MEDICARE: MS. CHRISTY KENNEDY EALY RN

MEDICARE: MS. CHRISTY KENNEDY EALY RN
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
1163W00000XRegistered NurseRN9423419FL
2163WH0200XHome Health Registered NurseRN9423419FL
3163WI0500XInfusion Therapy Registered NurseRN9423419FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN9423419OTHERFLFLORIDA BOARD OF NURSING

General Provider Information

NPI Number : 1366954612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTY KENNEDY EALY RN
Provider Business Mailing Address
First Line : 12235 NW 7TH LN
Second Line :
City : NEWBERRY
State : FL
Zip : 32669-2734
Country : US
Telephone Number : 352-333-2525
Fax Number : 888-276-7948
Provider Business Practice Location Address
First Line : 1700 NW 80TH BLVD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32606-9177
Country : US
Telephone Number : 352-333-2525
Fax Number : 352-333-2525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2017
Last Update Date : 10/26/2017

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