MEDICARE: PSK MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	363LF0000X	Family Nurse Practitioner
3	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1538794326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSK MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	1364 NW 121ST WAY
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-5274
Country	:	US
Telephone Number	:	352-888-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 SW BASCOM NORRIS DR STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1329
Country	:	US
Telephone Number	:	386-401-9778
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KRISTIN KAY
Credential	:	APRN, FNP-C
Telephone Number	:	352-888-2783

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	09/22/2021

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Directions to “PSK MANAGEMENT LLC ” Practice Location

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