Healthcare Provider Details

I. General information

NPI: 1922425560
Provider Name (Legal Business Name): CAROLINE R KISER D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BAPTIST CLAY DR STE 200
FLEMING ISLAND FL
32003-8505
US

IV. Provider business mailing address

PO BOX 746647
ATLANTA GA
30374-6647
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-6683
  • Fax: 904-376-3062
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4695
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number865
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: