=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417870783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RODAPHNE ADVANCED HEALTHCARE PROVIDER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1860 SW FOUNTAINVIEW BLVD STE 100
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-207-4900
-----------------------------------------------------
Fax | 772-404-7936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1860 SW FOUNTAINVIEW BLVD STE 100
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-207-4900
-----------------------------------------------------
Fax | 772-404-7936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NURSE PRACTITIONER
-----------------------------------------------------
Name | DR. KETTELENE PHILOGENE MCMORRIS
-----------------------------------------------------
Credential | DNP, FNP, PMHNP
-----------------------------------------------------
Telephone | 754-366-1406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------