Provider Demographics
NPI:1891707113
Name:KEMSLEY, JOAN O (PA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:O
Last Name:KEMSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:18308 MURDOCK CIR
Practice Address - Street 2:UNIT 105
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1025
Practice Address - Country:US
Practice Address - Phone:941-743-4150
Practice Address - Fax:941-743-4427
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9834304OtherAETNA
FLY0NY8OtherBCBS
FLP01406349OtherRR MEDICARE
FL9308885OtherCIGNA
FLP04453OtherFREEDOM
FL292061100Medicaid
FLP959330OtherOPTIMUM
FLP04453OtherFREEDOM
FL292061100Medicaid
FLP959330OtherOPTIMUM