Individual
ANGELA WHITE KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
(352) 527-6888
Mailing address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
(352) 527-8818
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA0000001010
TN
363AM0700X
Medical Physician Assistant
Primary
PA9105288
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3663478
—
TN
Enumeration date
04/25/2006
Last updated
06/27/2016
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