Kaley Puckett, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11015299 Issued in FL

Practice address

435 2ND St NE
Winter Haven, FL 33881-4103

Phone

(863) 333-5723

NPI assigned

Sep 14, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kaley Thorp Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EDIGBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Florida Infectious Diseases LLC

  • Infectious Disease Physician
  • Winter Haven, FL
  • NPI 1457590721
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1053081901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 CYPRESS CV",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338842509",
            "telephone_number": "863-289-7376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 2ND ST NE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814103",
            "telephone_number": "863-333-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "KALEY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11015299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALEY",
            "last_name": "THORP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Publix Super Markets Inc (Publix Pharmacy #0448)
• Publix Super Markets Inc (Publix Pharmacy #2117)
• Publix Super Markets Inc (Publix Pharmacy #1103)
• Publix Super Markets Inc (Publix Pharmacy #0425)
• Publix Super Markets Inc (Publix Pharmacy #2107)
• Enrique Zamora Puig, M.D.
• Valishti Artee Pundit, MD
• Katie Lynn Purdy, PA-C
• Pure Wellness & Aesthetics, LLC
• Alyssa Puretz, PTA

• Family Nurse Practitioner in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.