Provider Demographics
NPI:1275386419
Name:LAROCHE, KALEY
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:LAROCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:
Other - Last Name:BLIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1504 CHATHAM CT
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5050
Practice Address - Country:US
Practice Address - Phone:904-673-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program