Provider Demographics
NPI:1558991646
Name:K A COMPREHENSIVE MEDICAL AND PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:K A COMPREHENSIVE MEDICAL AND PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ACELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:561-410-4180
Mailing Address - Street 1:6801 LAKE WORTH RD STE 219
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2966
Mailing Address - Country:US
Mailing Address - Phone:561-328-8420
Mailing Address - Fax:561-828-2884
Practice Address - Street 1:6801 LAKE WORTH RD STE 219
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2966
Practice Address - Country:US
Practice Address - Phone:561-328-8420
Practice Address - Fax:561-828-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9203914OtherBLUE CROSS BLUE SHEILD, SUNSHINE, MEDICARE, UHC, AETNA, CIGNA