1285664342 NPI number — KELLY C ALEMAN LD RD CDE

Table of content: KELLY C ALEMAN LD RD CDE (NPI 1285664342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285664342 NPI number — KELLY C ALEMAN LD RD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEMAN
Provider First Name:
KELLY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LD RD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HODGE
Provider Other First Name:
KELLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285664342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 S FISKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-725-4500
Provider Business Mailing Address Fax Number:
321-951-7408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 GATEWAY DR # 1F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-725-4500
Provider Business Practice Location Address Fax Number:
321-409-5270
Provider Enumeration Date:
07/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  ND2844 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005515 . This is a "AMERICAN DIABETES ASSOCIATION DIABETIC EDUCATION CERTIFICATION NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".