Individual
MS. KELLY LEE THATCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-C
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD FL 1, TAMPA, FL 33607
(813) 870-4619
(813) 554-8956
Mailing address
PO BOX 10744, CLEARWATER, FL 33757-8744
(727) 532-0002
(727) 266-4943
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
9221346
FL
363LP2300X
Primary Care Nurse Practitioner
Primary
ARNP9221346
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023380000
—
FL
Enumeration date
08/23/2017
Last updated
08/31/2018
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