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NPI Code Detail

MEDICARE: ANGELA WHITE KELLEY PA-C

MEDICARE: ANGELA WHITE KELLEY PA-C
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
1363AM0700XMedical Physician AssistantPA0000001010TN
2363AM0700XMedical Physician AssistantPA9105288FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255397501
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA WHITE KELLEY PA-C
Provider Business Mailing Address
First Line : 1990 N PROSPECT AVE
Second Line :
City : LECANTO
State : FL
Zip : 34461-9792
Country : US
Telephone Number : 352-527-6888
Fax Number : 352-527-8818
Provider Business Practice Location Address
First Line : 1990 N PROSPECT AVE
Second Line :
City : LECANTO
State : FL
Zip : 34461-9792
Country : US
Telephone Number : 352-527-6888
Fax Number : 352-527-6888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 06/27/2016

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Directions to “ ANGELA WHITE KELLEY PA-C” Practice Location

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