MEDICARE: MANJIT KAUR KAELEY 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	163W00000X	Registered Nurse	9287546	FL
2	163W00000X	Registered Nurse	476072-1	NY
3	163W00000X	Registered Nurse	RN00137341	WA
4	363LF0000X	Family Nurse Practitioner	9287546	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1417385949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJIT KAUR KAELEY ARNP

Provider Business Mailing Address
First Line	:	326 PABLO RD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1806
Country	:	US
Telephone Number	:	904-686-1749
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 EDGEWOOD AVE N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-3013
Country	:	US
Telephone Number	:	904-633-0510
Fax Number	:

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

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	06/09/2016

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