Individual
CARLY ELIZABETH KITCHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 E HALLANDALE BEACH BLVD, SUITE PH2, HALLANDALE BEACH, FL 33009-4834
(954) 456-6500
Mailing address
2209 NE 17TH TER, WILTON MANORS, FL 33305-2415
(786) 346-8423
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107089
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1228580
WELLCARE
FL
01
—
398644
AVMED
FL
01
—
4601154
CIGNA
FL
01
—
4807363
AETNA
FL
01
—
P01467310
RR MEDICARE
FL
01
—
P1027784
FREEDOM
FL
01
—
P965151
OPTIMUM
FL
01
—
PA9107089
PA LICENSE
FL
01
—
Y0QL1
BCBS
FL
Enumeration date
03/06/2013
Last updated
12/14/2016
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