Healthcare Provider Details

I. General information

NPI: 1497190508
Provider Name (Legal Business Name): KELLEY TEW KINDELSPIRE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 10TH ST
MALONE FL
32445-3429
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-569-2053
  • Fax: 850-569-2062
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-872-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9292260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: