Healthcare Provider Details

I. General information

NPI: 1700722626
Provider Name (Legal Business Name): KELSEY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY HOVERKAMP

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5654 CYPRESS GARDENS BLVD SUITE 103 SUITE 103
WINTER HAVEN FL
33884-3520
US

IV. Provider business mailing address

5654 CYPRESS GARDENS BLVD STE 103
WINTER HAVEN FL
33884-2272
US

V. Phone/Fax

Practice location:
  • Phone: 863-557-5948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN9424843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: