Provider Demographics
NPI:1962158311
Name:CLAXTON, KERLEEN V
Entity type:Individual
Prefix:
First Name:KERLEEN
Middle Name:V
Last Name:CLAXTON
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 1:2357 ALABASTER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3954
Mailing Address - Country:US
Mailing Address - Phone:407-965-9962
Mailing Address - Fax:407-250-4451
Practice Address - Street 1:1850 N ALAFAYA TRL STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4745
Practice Address - Country:US
Practice Address - Phone:321-588-9364
Practice Address - Fax:407-250-4451
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist