Individual
KIMBERLY JEAN ELLIS-KOCEJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4952 GRASSY POND RD, CHIPLEY, FL 32428-5547
(850) 596-4137
Mailing address
4523 NORTHSHORE RD, LYNN HAVEN, FL 32444-3478
(850) 596-4137
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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