Provider Demographics
NPI:1972670396
Name:VALLE, KELLEY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:LOUISE
Last Name:VALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:DAUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6960
Mailing Address - Country:US
Mailing Address - Phone:305-293-6991
Mailing Address - Fax:305-293-9896
Practice Address - Street 1:412 WHITE ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6960
Practice Address - Country:US
Practice Address - Phone:305-293-6991
Practice Address - Fax:305-293-9896
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74691207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0793YMedicare PIN
G75030Medicare UPIN