Provider Demographics
NPI:1558782284
Name:NUGENT, KELLEY (PA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6409
Mailing Address - Country:US
Mailing Address - Phone:561-968-8462
Mailing Address - Fax:561-721-1342
Practice Address - Street 1:2070 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-6409
Practice Address - Country:US
Practice Address - Phone:561-968-8462
Practice Address - Fax:561-721-1342
Is Sole Proprietor?:No
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107596363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical