Clouse, Kelly T

Clouse, Kelly T is an individual health care provider with primary practice located at 2021 Professional Center Dr Ste 101 , Orange Park FL 32073-4461. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Clouse, Kelly T can be contacted via phone (904) 213-9210.

Contact Information

Primary practice address
2021 Professional Center Dr Ste 101 Orange Park FL 32073-4461
Phone: (904) 213-9210
Fax: (904) 213-9211
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X ME110938 Florida
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 46974 Wisconsin

Profile Details

NPI number 1932104288
LBN Legal business name Clouse, Kelly T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2005
Last updated Jan 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932104288 NPPES
Wisconsin MEDICAID 34564000

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