1184270209 NPI number — MRS. KELLY RAMOS APRN, FNP-BC

Table of content: MRS. KELLY RAMOS APRN, FNP-BC (NPI 1184270209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184270209 NPI number — MRS. KELLY RAMOS APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS
Provider First Name:
KELLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1184270209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 JUPITER LAKES BLVD STE 4105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-7190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-743-9938
Provider Business Mailing Address Fax Number:
561-575-0801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2628 SE FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-219-9362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2019

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: 163WE0003X , with the licence number:  RN9312491 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN11005031 , 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: 1184270209 . This is a "MEDICARE MEDICAID AND OTHER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com