Individual
KATHRYN MARIE COUTURE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3003 W DR MARTIN LUTHER KING JR BLVD, CHRONIC COMPLEX CLINIC, TAMPA, FL 33607-6307
(813) 554-8121
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
(813) 974-2201
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01071090A
IN
208000000X
Pediatrics Physician
ME121021
FL
208M00000X
Hospitalist Physician
Primary
ME121201
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014414200
—
FL
01
—
14T3P
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/28/2009
Last updated
02/04/2022
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