Healthcare Provider Details

I. General information

NPI: 1316853302
Provider Name (Legal Business Name): MRS. KALEY SUSANNE KENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SUNSET POINT DR
ORMOND BEACH FL
32174-8751
US

IV. Provider business mailing address

250 SUNSET POINT DR
ORMOND BEACH FL
32174-8751
US

V. Phone/Fax

Practice location:
  • Phone: 386-562-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: