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Individual
KELLY G COUGHLIN
Active
Individual
KELLY G COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9109645
FL
363AM0700X
Medical Physician Assistant
PA9109645
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0206416-00
—
FL
01
—
5DKRV
BCBS
FL
01
—
P01721293
RAILROAD MEDICARE
FL
01
—
P01721294
RAILROAD MEDICARE
FL
Enumeration date
06/21/2016
Last updated
07/02/2024
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