Healthcare Provider Details

I. General information

NPI: 1114837325
Provider Name (Legal Business Name): KOMPASSIONATE KARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414B 7TH ST W STE 2
PALMETTO FL
34221-5209
US

IV. Provider business mailing address

414B 7TH ST W STE 2
PALMETTO FL
34221-5209
US

V. Phone/Fax

Practice location:
  • Phone: 941-877-9191
  • Fax: 270-220-0533
Mailing address:
  • Phone: 941-877-9191
  • Fax: 270-220-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS KIA N. MCDUFFIE
Title or Position: OWNER
Credential: APRN
Phone: 941-877-9191