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NPI Code Detail

MEDICARE: MAVRA E KEAR PHD, ARNP, BC

MEDICARE: MAVRA E KEAR PHD, ARNP, BC
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
1363LP2300XPrimary Care Nurse PractitionerAPRN1613842FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2566717000OTHERFLMAGELLAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558357418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAVRA E KEAR PHD, ARNP, BC
Provider Business Mailing Address
First Line : PO BOX 1559
Second Line :
City : BARTOW
State : FL
Zip : 33831-1559
Country : US
Telephone Number : 863-519-0575
Fax Number : 863-582-9251
Provider Business Practice Location Address
First Line : 1831 GILMORE AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33805-3017
Country : US
Telephone Number : 863-519-0575
Fax Number : 863-582-9251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 11/25/2019

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