Healthcare Provider Details

I. General information

NPI: 1043009061
Provider Name (Legal Business Name): MRS. DAWN E KPELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTER CREEK RD STE 108
ST AUGUSTINE FL
32084-0022
US

IV. Provider business mailing address

100 CENTER CREEK RD STE 108
ST AUGUSTINE FL
32084-0022
US

V. Phone/Fax

Practice location:
  • Phone: 904-522-4399
  • Fax:
Mailing address:
  • Phone: 904-522-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: