Provider Demographics
NPI:1437753316
Name:GRAMER, KELLY ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:GRAMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3466 PINE RIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3883
Mailing Address - Country:US
Mailing Address - Phone:239-261-2663
Mailing Address - Fax:239-262-5633
Practice Address - Street 1:3466 PINE RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3883
Practice Address - Country:US
Practice Address - Phone:239-261-2663
Practice Address - Fax:239-262-5633
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9113499363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant