Provider Demographics
NPI:1417385949
Name:KAELEY, MANJIT KAUR (ARNP)
Entity Type:Individual
Prefix:
First Name:MANJIT
Middle Name:KAUR
Last Name:KAELEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 PABLO RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1806
Mailing Address - Country:US
Mailing Address - Phone:904-686-1749
Mailing Address - Fax:
Practice Address - Street 1:761 EDGEWOOD AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3013
Practice Address - Country:US
Practice Address - Phone:904-633-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9287546163W00000X, 363LF0000X
NY476072-1163W00000X
WARN00137341163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010132200Medicaid
FL010132200Medicaid
FLHP695ZMedicare PIN