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General NPI Number Information
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NPI Number | 1679923601
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Entity Type | Individual
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Provider Name | KELLY G COUGHLIN PA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 6716 NW 11TH PLACE STE 200
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City | GAINESVILLE
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State | FL
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Zip | 32605-4215
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Country | US
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Telephone | 352-331-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 6716 NW 11TH PL STE 200
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City | GAINESVILLE
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State | FL
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Zip | 32605-4201
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Country | US
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Telephone | 352-313-6825
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Fax | 352-331-0137
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109645
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9109645
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License Number State | FL
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