Provider Demographics
NPI:1285216234
Name:DUPERA, KELVIN (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:
Last Name:DUPERA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2568
Mailing Address - Country:US
Mailing Address - Phone:863-261-8354
Mailing Address - Fax:863-638-5637
Practice Address - Street 1:308 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2568
Practice Address - Country:US
Practice Address - Phone:863-261-8354
Practice Address - Fax:863-638-5637
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012550363LP0808X
FL9413104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty