Healthcare Provider Details

I. General information

NPI: 1740586288
Provider Name (Legal Business Name): KELLIE KILPATRICK BATTILLO FNP-C, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEMORIAL MEDICAL PKWY STE 3805
PALM COAST FL
32164-5982
US

IV. Provider business mailing address

76 S ST ANDREWS DR
ORMOND BEACH FL
32174-3857
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1605
  • Fax: 386-586-1607
Mailing address:
  • Phone: 321-662-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9179951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: