Healthcare Provider Details

I. General information

NPI: 1699220426
Provider Name (Legal Business Name): KEMLINE METELLUS DORVIL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N CONGRESS AVE STE 203
WEST PALM BEACH FL
33407-3381
US

IV. Provider business mailing address

4601 N CONGRESS AVE STE 203
WEST PALM BEACH FL
33407-3381
US

V. Phone/Fax

Practice location:
  • Phone: 561-429-2401
  • Fax: 561-429-2931
Mailing address:
  • Phone: 561-429-2401
  • Fax: 561-429-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG0416062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: