MEDICARE: KELLEY NUGENT PA

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	363AM0700X	Medical Physician Assistant	PA9107596	FL

General Provider Information

NPI Number	:	1558782284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY NUGENT PA

Provider Business Mailing Address
First Line	:	2070 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6409
Country	:	US
Telephone Number	:	561-968-8462
Fax Number	:	561-721-1342

Provider Business Practice Location Address
First Line	:	2070 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6409
Country	:	US
Telephone Number	:	561-968-8462
Fax Number	:	561-721-1342

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

Provider Enumeration Date	:	12/24/2013
Last Update Date	:	12/24/2013

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Directions to “ KELLEY NUGENT PA” Practice Location

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