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General NPI Number Information
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NPI Number | 1538794326
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Entity Type | Organization
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Legal Business Name | PSK MANAGEMENT LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1140 SW BASCOM NORRIS DR STE 101
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City | LAKE CITY
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State | FL
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Zip | 32025-1329
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Country | US
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Telephone | 386-401-9778
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Fax |
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Provider Business Mailing Address
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Address Line | 1364 NW 121ST WAY
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City | GAINESVILLE
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State | FL
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Zip | 32606-5274
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Country | US
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Telephone | 352-888-2783
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTIN KAY
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Credential | APRN, FNP-C
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Telephone | 352-888-2783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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