Provider Demographics
NPI:1609903376
Name:CASIMIR, KETTLY KIMBERLYNN (CRNP F)
Entity Type:Individual
Prefix:MISS
First Name:KETTLY
Middle Name:KIMBERLYNN
Last Name:CASIMIR
Suffix:
Gender:F
Credentials:CRNP F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12171 SW 268TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8001
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:
Practice Address - Street 1:12171 SW 268TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8001
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158892363LF0000X
DCRN1005964363LF0000X
FLARNP2596372363LF0000X
OKR0088547364SF0001X
NY4288531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health