Dominessy, Kellie Lynn

Dominessy, Kellie Lynn is an individual health care provider with primary practice located at 2307 W Broward Blvd Ste 200, Fort Lauderdale FL 33312-1417. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Dominessy, Kellie Lynn can be contacted via phone (954) 792-1010.

Contact Information

Primary practice address
2307 W Broward Blvd Ste 200 Fort Lauderdale FL 33312-1417
Phone: (954) 792-1010
Fax: (954) 792-1199
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9105661 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9105661 Florida

Profile Details

NPI number 1932403383
LBN Legal business name Dominessy, Kellie Lynn
Credentials PA-C, MMS, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2010
Last updated Mar 28th, 2016 - about 8 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 1932403383 NPPES
Florida MEDICAID 003180000
Florida Other Y06HZ

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