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General NPI Number Information
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NPI Number | 1184053498
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Entity Type | Individual
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Provider Name | KIMBERLEY KLECKNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 14470 HARLEE RD
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City | PALMETTO
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State | FL
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Zip | 34221-9600
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Country | US
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Telephone | 941-747-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 437 MIRABAY BLVD
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City | APOLLO BEACH
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State | FL
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Zip | 33572-3412
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Country | US
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Telephone | 973-412-5610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TRN17489
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60528246
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME121675
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License Number State | FL
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