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General NPI Number Information
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NPI Number | 1902664568
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Entity Type | Individual
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Provider Name | KELLI KNIGHT OVERTURF APRN
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Gender | Female
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 1630 MASON AVE STE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4503
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Country | US
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Telephone | 386-238-9064
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Fax | 386-238-9063
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Provider Business Mailing Address
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Address Line | 2148 WATER PLANT RD
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-9203
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Country | US
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Telephone | 904-307-0103
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN11031702
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License Number State | FL
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