Provider Demographics
NPI:1780142166
Name:SHAVER, KAYLEIGH MORGAN (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MORGAN
Last Name:SHAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-6232
Mailing Address - Fax:855-975-0615
Practice Address - Street 1:2155 OLD MOULTRIE RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5102
Practice Address - Country:US
Practice Address - Phone:904-877-1300
Practice Address - Fax:904-506-2005
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9114468OtherFL PA LICENSE