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General NPI Number Information
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NPI Number | 1821206566
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Entity Type | Individual
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Provider Name | KELLEY THOMASON PRENTICE ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 414 CAPE CORAL PKWY E STE 201
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City | CAPE CORAL
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State | FL
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Zip | 33904-8522
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Country | US
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Telephone | 239-424-3278
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Fax | 239-343-4133
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Provider Business Mailing Address
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Address Line | 3208 CHIQUITA BLVD S STE 110
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City | CAPE CORAL
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State | FL
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Zip | 33914-4267
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Country | US
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Telephone | 239-574-8463
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Fax | 239-574-8491
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9220789
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License Number State | FL
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