Individual
KANESSIA Q EMORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
755 27TH AVE SW STE 9&10, VERO BEACH, FL 32968-4200
(407) 285-8139
Mailing address
4631 S 25TH ST, FORT PIERCE, FL 34981-5037
(407) 285-8139
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E560-515-91-790-0
PROVIDE INSURANCE
FL
05
—
E560-515-91-790-0
—
FL
Enumeration date
04/09/2018
Last updated
03/04/2021
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