Individual
KELLY DYESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32886-3026
(904) 308-7300
(904) 346-0113
Mailing address
PO BOX 100186, GAINESVILLE, FL 32610-3026
(352) 265-5911
(352) 265-5606
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS9198
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276257900
—
FL
01
—
P00346860
RAILROAD MEDICARE
FL
Enumeration date
08/24/2006
Last updated
03/28/2024
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