Healthcare Provider Details

I. General information

NPI: 1053117200
Provider Name (Legal Business Name): KINSEY STAPLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 SHELL POINT PLZ STE 110
FORT MYERS FL
33908-3504
US

IV. Provider business mailing address

166 SE 18TH ST
CAPE CORAL FL
33990-2226
US

V. Phone/Fax

Practice location:
  • Phone: 239-415-5477
  • Fax: 239-454-2111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: