Provider Demographics
NPI:1871266981
Name:KAPKA, KELSEY HOPE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:HOPE
Last Name:KAPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-3220
Mailing Address - Country:US
Mailing Address - Phone:954-647-0925
Mailing Address - Fax:
Practice Address - Street 1:2415 MOORES MILL RD UNIT 230
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8483
Practice Address - Country:US
Practice Address - Phone:334-502-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009152363LF0000X
AL1-197784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily