Provider Demographics
NPI:1053081901
Name:PUCKETT, KALEY (APRN)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 CYPRESS CV
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2509
Mailing Address - Country:US
Mailing Address - Phone:863-289-7376
Mailing Address - Fax:
Practice Address - Street 1:435 2ND ST NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4103
Practice Address - Country:US
Practice Address - Phone:863-333-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily