Healthcare Provider Details

I. General information

NPI: 1730333824
Provider Name (Legal Business Name): KELLY A SHREVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 S HEALTHPARK DR SUITE 410
FORT MYERS FL
33908-7603
US

IV. Provider business mailing address

9800 S HEALTHPARK DR SUITE 410
FORT MYERS FL
33908-7603
US

V. Phone/Fax

Practice location:
  • Phone: 239-433-6760
  • Fax: 239-433-6766
Mailing address:
  • Phone: 239-433-6760
  • Fax: 239-433-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9280311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: