Individual
MS. KERRY KATHLEEN SHUFFELBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 BLUE MOON XING STE 203, POOLER, GA 31322-9698
(912) 590-0973
(912) 590-0180
Mailing address
5191 FIRST COAST TECH PKWY FL 3, JACKSONVILLE, FL 32224-0609
(904) 223-3321
(904) 223-2169
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2131
SC
363AM0700X
Medical Physician Assistant
2131
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0032613-00
—
FL
01
—
Y06PS
BCBS
FL
Enumeration date
01/28/2011
Last updated
10/12/2023
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