Provider Demographics
NPI:1629768452
Name:PIEDRAHITA, KELLY CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:PIEDRAHITA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:16228 SEA TURTLE PL
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 N DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2717
Practice Address - Country:US
Practice Address - Phone:817-739-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9117426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant