Provider Demographics
NPI:1609554484
Name:WYMAN, KELLY (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10275 COLLINS AVE APT 925
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1452
Mailing Address - Country:US
Mailing Address - Phone:954-649-0246
Mailing Address - Fax:
Practice Address - Street 1:10275 COLLINS AVE APT 925
Practice Address - Street 2:
Practice Address - City:BAL HARBOUR
Practice Address - State:FL
Practice Address - Zip Code:33154-1452
Practice Address - Country:US
Practice Address - Phone:954-649-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily