Healthcare Provider Details

I. General information

NPI: 1619840766
Provider Name (Legal Business Name): DR. KALEIGH URBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S HOOVER BLVD STE 202
TAMPA FL
33609-3574
US

IV. Provider business mailing address

10980 OAK ST NE UNIT 1309
ST PETERSBURG FL
33716-3350
US

V. Phone/Fax

Practice location:
  • Phone: 813-812-5411
  • Fax:
Mailing address:
  • Phone: 813-812-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: