Basic Information
| Provider Information | |||||||||
| NPI: | 1144476920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KICLITER-KELLEY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 N LAWNWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349504825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724623800 | ||||||||
| FaxNumber: | 7724623865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 SE HILLMOOR DR | ||||||||
| Address2: | SUITE B109 | ||||||||
| City: | PORT SAINT LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349527553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723379473 | ||||||||
| FaxNumber: | 7723370796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | ARNP9198526 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.