Provider Demographics
NPI:1598599813
Name:BARTHELEMY, KERLINE
Entity type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:BARTHELEMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 SW CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1730
Mailing Address - Country:US
Mailing Address - Phone:475-685-0578
Mailing Address - Fax:
Practice Address - Street 1:8980 S US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3482
Practice Address - Country:US
Practice Address - Phone:772-788-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant