Healthcare Provider Details

I. General information

NPI: 1215313945
Provider Name (Legal Business Name): KATHI L SUMERALL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHI L PADILLA CNM

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S STE 310
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

9320 US HIGHWAY 301 S STE 310
RIVERVIEW FL
33578-6300
US

V. Phone/Fax

Practice location:
  • Phone: 813-328-3158
  • Fax:
Mailing address:
  • Phone: 813-328-3158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN9367085
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9367085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: