MEDICARE: MRS. DEBORAH ANN KICLITER-KELLEY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9198526	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9198526	FL
3	363LW0102X	Women's Health Nurse Practitioner	ARNP9198526	FL

General Provider Information

NPI Number	:	1144476920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH ANN KICLITER-KELLEY ARNP

Provider Business Mailing Address
First Line	:	1301 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4825
Country	:	US
Telephone Number	:	772-462-3800
Fax Number	:	772-462-3865

Provider Business Practice Location Address
First Line	:	1801 SE HILLMOOR DR
Second Line	:	SUITE B109
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7553
Country	:	US
Telephone Number	:	772-337-9473
Fax Number	:	772-337-0796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	03/01/2025

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