1962630277 NPI number — DR. REBEKAH ANNE KEMP OD

Table of content: DR. REBEKAH ANNE KEMP OD (NPI 1962630277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962630277 NPI number — DR. REBEKAH ANNE KEMP OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEMP
Provider First Name:
REBEKAH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
REBEKAH
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962630277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5290 SEMINOLE BLVD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33708-3369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-800-4411
Provider Business Mailing Address Fax Number:
727-491-5075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5290 SEMINOLE BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33708-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-800-4411
Provider Business Practice Location Address Fax Number:
727-491-5075
Provider Enumeration Date:
06/25/2009

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: 152W00000X , with the licence number:  OPC4673 , 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: 112170900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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