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NPI Code Detail

MEDICARE: MRS. KETSIA AURELIEN A-GNP NURSE PRACTITI

MEDICARE: MRS. KETSIA AURELIEN A-GNP NURSE PRACTITI
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 Practitioner9311187FL

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 : 1598247314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KETSIA AURELIEN A-GNP NURSE PRACTITI
Provider Business Mailing Address
First Line : 28 E MAIN ST UNIT 126
Second Line :
City : AVON PARK
State : FL
Zip : 33825-3943
Country : US
Telephone Number : 786-459-4226
Fax Number : 458-200-3014
Provider Business Practice Location Address
First Line : 4638 SUN N LAKE BLVD
Second Line :
City : SEBRING
State : FL
Zip : 33872-2176
Country : US
Telephone Number : 863-386-0055
Fax Number : 863-386-0118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 06/10/2026

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