Provider Demographics
NPI:1720623036
Name:POLEY, KEVAN MICHAEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEVAN
Middle Name:MICHAEL
Last Name:POLEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S MAGNOLIA DR APT K202
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4681
Mailing Address - Country:US
Mailing Address - Phone:850-450-9096
Mailing Address - Fax:
Practice Address - Street 1:1921 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4492
Practice Address - Country:US
Practice Address - Phone:850-575-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003136207QA0505X, 207RN0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology