MEDICARE: KESANN KINA DORMAND

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	363LF0000X	Family Nurse Practitioner	APRN11007334	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	:	1639794282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESANN KINA DORMAND

Provider Business Mailing Address
First Line	:	9121 N MILITARY TRL STE 111
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5985
Country	:	US
Telephone Number	:	561-626-7604
Fax Number	:	877-266-6973

Provider Business Practice Location Address
First Line	:	9121 N MILITARY TRL STE 111
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5985
Country	:	US
Telephone Number	:	561-626-7604
Fax Number	:	877-266-6973

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

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	01/23/2026

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Directions to “ KESANN KINA DORMAND ” Practice Location

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