Healthcare Provider Details

I. General information

NPI: 1396586442
Provider Name (Legal Business Name): KELLEE RIE EDMUND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/29/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9032 PERKINS RD
BATON ROUGE LA
70810-1507
US

IV. Provider business mailing address

146 S WEST SHORE BLVD STE 128 C
TAMPA FL
33609
US

V. Phone/Fax

Practice location:
  • Phone: 225-358-4853
  • Fax:
Mailing address:
  • Phone: 813-358-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040043
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9684963
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18865700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230421
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: