Healthcare Provider Details

I. General information

NPI: 1689509655
Provider Name (Legal Business Name): KIMBERLY CAITLYN LEYS ARNP,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 VIRGINIA AVE
FORT PIERCE FL
34981-5515
US

IV. Provider business mailing address

3851 VIRGINIA AVE
FORT PIERCE FL
34981-5515
US

V. Phone/Fax

Practice location:
  • Phone: 772-882-4919
  • Fax:
Mailing address:
  • Phone: 772-882-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: