Provider Demographics
NPI:1699220426
Name:DORVIL, KEMLINE METELLUS (NP-C)
Entity Type:Individual
Prefix:
First Name:KEMLINE
Middle Name:METELLUS
Last Name:DORVIL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2917
Mailing Address - Country:US
Mailing Address - Phone:561-429-2401
Mailing Address - Fax:561-429-2931
Practice Address - Street 1:400 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2917
Practice Address - Country:US
Practice Address - Phone:561-429-2401
Practice Address - Fax:561-429-2931
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG0416062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner