Individual
KELLY T CLOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 DEERFIELD PRESERVE BLVD, ST AUGUSTINE, FL 32086-5966
(904) 823-2896
Mailing address
100 DEERFIELD PRESERVE BLVD, ST AUGUSTINE, FL 32086-5966
(904) 823-2896
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
46974
WI
2084P0800X
Psychiatry Physician
Primary
ME110938
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34564000
—
WI
Enumeration date
06/14/2005
Last updated
04/28/2026
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