Healthcare Provider Details

I. General information

NPI: 1982422879
Provider Name (Legal Business Name): KELLI FOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S HARBOR CITY BLVD STE 610
MELBOURNE FL
32901-5591
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-7716
  • Fax:
Mailing address:
  • Phone: 321-723-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9119545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: