=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669280459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KASSIE NICOLE KINDER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2024
-----------------------------------------------------
Last Update Date | 12/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 885 SE 6TH AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-815-4074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9985 EMMONS RD
-----------------------------------------------------
City | ASHFORD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25009-9598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-437-0539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11036517
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------