Provider Demographics
NPI:1598247314
Name:AURELIEN, KETSIA (A-GNP NURSE PRACTITI)
Entity type:Individual
Prefix:MRS
First Name:KETSIA
Middle Name:
Last Name:AURELIEN
Suffix:
Gender:
Credentials:A-GNP NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E MAIN ST UNIT 126
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-3943
Mailing Address - Country:US
Mailing Address - Phone:786-459-4226
Mailing Address - Fax:458-200-3014
Practice Address - Street 1:5200 NE 2ND AVE FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-762-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9311187363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care