KELLY GENDALL MD NPI 1942418579

NPI Information

NPI: 1942418579
Provider Name: KELLY GENDALL, MD
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1215 DUNN AVE STE 1
JACKSONVILLE, FL
ZIP 32218
Phone: (904) 696-7474
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Kelly Gendall, MD is a general practice in Jacksonville, FL. Kelly Gendall, MD NPI is 1942418579. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1215 DUNN AVE STE 1
JACKSONVILLE, FL
ZIP 32218-897
Phone: (904) 696-7474
Fax: (904) 696-7476

The NPI 1942418579 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/18/2007 and was last updated on 1/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		ME132441	FLORIDA	No
2	208D00000X	General Practice		ME132441	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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