Healthcare Provider Details

I. General information

NPI: 1720520687
Provider Name (Legal Business Name): CHRISTOPHER JAMES KALLINGER PA-C, MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 NIRA ST
JACKSONVILLE FL
32207-8652
US

IV. Provider business mailing address

6650 CORPORATE CENTER PKWY APT 208
JACKSONVILLE FL
32216-0988
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4991
  • Fax:
Mailing address:
  • Phone: 321-356-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9110002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: