Kidney Center of Tradition LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KIDNEY CENTER OF TRADITION LLC

Doing business as

Gatlin Kidney Care

Practice address

1631 SW Gatlin Blvd
Suite 100
Port St Lucie, FL 34953-4103

Phone

(772) 343-7425

Fax

(772) 343-7687

NPI assigned

Aug 28, 2017

Last updated

Aug 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keisha Denise Greene

Title

VP of Clinical & Regulatory

Phone

(978) 522-3905

Specialties & licenses 1

Addresses

Other names 1

• GATLIN KIDNEY CARE Doing business as

Locations

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1184141350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 SW GATLIN BLVD",
            "address_2": "SUITE 100",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349534103",
            "telephone_number": "772-343-7425",
            "fax_number": "772-343-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 SW GATLIN BLVD",
            "address_2": "SUITE 100",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349534103",
            "telephone_number": "772-343-7425",
            "fax_number": "772-343-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CENTER OF TRADITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "VP OF CLINICAL & REGULATORY",
        "authorized_official_telephone_number": "978-522-3905"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GATLIN KIDNEY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Victoria Kenyon
• Jocelyn Kercy
• Kerri a. Krieger, DPT, PA
• Surendra P Khera, MD
• George Khoudari, MD
• Kids First Therapy Solutions
• Kidz Medical Services
• Kathryn Hope Kiernan
• Ga Hee Kim
• Hayden Kim, DO

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.