Healthcare Provider Details

I. General information

NPI: 1891707113
Provider Name (Legal Business Name): JOAN O KEMSLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18308 MURDOCK CIR UNIT 105
PT CHARLOTTE FL
33948-1025
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIALING
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 941-743-4150
  • Fax: 941-743-4427
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: