Provider Demographics
NPI:1396586442
Name:EDMUND, KELLEE RIE (RN)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:RIE
Last Name:EDMUND
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:146 S WEST SHORE BLVD
Mailing Address - Street 2:STE 128 C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-358-6814
Mailing Address - Fax:
Practice Address - Street 1:9032 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1507
Practice Address - Country:US
Practice Address - Phone:225-358-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9684963163W00000X
NJ26NR18865700163W00000X
LA230421163W00000X
FLAPRN11040043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse