Provider Demographics
NPI:1174599328
Name:KLYMKO, KAY LOUISE (FNP)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:LOUISE
Last Name:KLYMKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHN ANDERSON DR
Mailing Address - Street 2:UNIT 103
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-5768
Mailing Address - Country:US
Mailing Address - Phone:810-357-6670
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN ANDERSON DR
Practice Address - Street 2:UNIT 103
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-5767
Practice Address - Country:US
Practice Address - Phone:810-357-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9364769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
B49173Medicare UPIN