Staple, Keith A

Staple, Keith A is an individual health care provider with primary practice located at 3763 Evans Ave , Fort Myers FL 33901-9302. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Staple, Keith A can be contacted via phone (239) 931-9812.

Contact Information

Primary practice address
3763 Evans Ave Fort Myers FL 33901-9302
Phone: (239) 931-9812
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1073955035
LBN Legal business name Staple, Keith A
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2013
Last updated Jul 19th, 2013 - about 13 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 1073955035 NPPES
Florida MEDICAID 591287693

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