Healthcare Provider Details

I. General information

NPI: 1114327368
Provider Name (Legal Business Name): KELSEY PAULK MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 23RD ST STE B20
PANAMA CITY FL
32405-3936
US

IV. Provider business mailing address

700 W 23RD ST STE B20
PANAMA CITY FL
32405-3936
US

V. Phone/Fax

Practice location:
  • Phone: 850-348-1057
  • Fax:
Mailing address:
  • Phone: 850-348-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: