Healthcare Provider Details

I. General information

NPI: 1154238434
Provider Name (Legal Business Name): KAYLEE NYCOLE SOMERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2954 MALLORY CIR STE 101
CELEBRATION FL
34747-1822
US

IV. Provider business mailing address

2954 MALLORY CIR STE 101
CELEBRATION FL
34747-1822
US

V. Phone/Fax

Practice location:
  • Phone: 321-939-0222
  • Fax:
Mailing address:
  • Phone: 321-939-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: