Provider Demographics
NPI:1750109393
Name:REMY, JOSEPH KELLY (SDVOSB)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KELLY
Last Name:REMY
Suffix:
Gender:M
Credentials:SDVOSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 NW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-2840
Mailing Address - Country:US
Mailing Address - Phone:318-658-5227
Mailing Address - Fax:
Practice Address - Street 1:3280 W POWERS AVE STE E
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-2403
Practice Address - Country:US
Practice Address - Phone:318-658-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker