Provider Demographics
NPI:1558939702
Name:BABBIE, KELLY DOROTHY (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DOROTHY
Last Name:BABBIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DOROTHY
Other - Last Name:PAVILAITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1800
Mailing Address - Fax:239-343-4041
Practice Address - Street 1:5705 LEE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6342
Practice Address - Country:US
Practice Address - Phone:239-343-1800
Practice Address - Fax:239-343-4041
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025793363LF0000X
NYF347771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119529600Medicaid
NY06626159Medicaid