Basic Information
| Provider Information | |||||||||
| NPI: | 1316045222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUERDEN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 628296 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328628296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077419418 | ||||||||
| FaxNumber: | 9043460113 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 W STATE ROAD 434 | ||||||||
| Address2: | |||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327505119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077671200 | ||||||||
| FaxNumber: | 9043460113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP7349 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 500020214 | 01 | FL | RAILROAD MEDICARE | OTHER |