KELLIE LYNN DOMINESSY (NPI# 1932403383) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932403383 |
| Entity Type | Individual |
| Full Name | KELLIE LYNN DOMINESSY |
| Credential | PA-C, MMS, ATC |
| Practice Address |
2307 W Broward Blvd Ste 200 Fort Lauderdale FL 33312-1417 |
| Practice Telephone | 9547921010 |
| Practice Fax Number | 9547921199 |
| Mailing Telephone | 9547921010 |
| Mailing Fax Number | 9547921199 |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2016-03-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA9105661 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9105661 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 003180000 | 05 | |
| FL | BCBS | Y06HZ | 01 |
| Street Address |
2307 W BROWARD BLVD STE 200 |
| City | FORT LAUDERDALE |
| State | FL |
| Zip Code | 33312-1417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699730713 | George L Caldwell | Orthopaedic Surgery | 2307 W Broward Blvd, Ste 200, Fort Lauderdale, FL 33312-1417 | 2006-04-20 |
| 1235687690 | Michael Selepec | Physician Assistant | 2307 W Broward Blvd, Ste 200, Fort Lauderdale, FL 33312 | 2016-09-14 |
| 1154567063 | Mikel Calderon | Physician Assistant | 2307 W Broward Blvd, Ste 200, Fort Lauderdale, FL 33312-1417 | 2008-12-23 |
| 1407811524 | William Vincent Burke | Orthopaedic Surgery | 2307 W Broward Blvd, Ste 200, Fort Lauderdale, FL 33312-1417 | 2006-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679112965 | Krista Moreno | Marriage & Family Therapist | 2699 Stirling Road Building C Suite 403e, Fort Lauderdale, FL 33312 | 2020-01-03 |
| 1700428026 | Caring Village of Lauderdale LLC | Assisted Living Facility | 408-412 Sw 7th Ave, Fort Lauderdale, FL 33312 | 2019-10-09 |
| 1548742356 | Inspire Acupuncture | Acupuncturist | 1000 Riverside Drive, Fort Lauderdale, FL 33312 | 2018-08-29 |
| 1447762919 | Daniel Desta Bekele | General Practice | 1001 W Las Olas Blvd Apt 4, Fort Lauderdale, FL 33312 | 2017-10-24 |
| 1649798653 | Angel Luis Perez | Nurse Practitioner | 3041 Sw 47 Street, Fort Lauderdale, FL 33312 | 2017-08-30 |
| 1902322738 | Ashley Ingrid Rini | Dentist | 1620 Sw 33rd Ave, Fort Lauderdale, FL 33312 | 2017-08-14 |
| 1548794993 | Elise Cruz | Nurse Practitioner | 3301 Sw 16th Street, Fort Lauderdale, FL 33312 | 2017-04-12 |
| 1619415924 | Antoinette Battle | Nurse Practitioner | 3470 Sw 19th Street, Fort Lauderdale, FL 33312 | 2017-02-07 |
| 1902344252 | Melissa Miller | Counselor | 2962 Southwest 26th Terrace, 204, Fort Lauderale, FL 33312 | 2017-02-07 |
| 1164975934 | Brandon Nieves Stella | Technician, Other | 620 Sw 14th Ter, Fort Lauderdale, FL 33312 | 2016-07-28 |
| Find all providers in zip 33312 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154885010 | Chelsea Sophia Zaccario | Physician Assistant | 1625 Se 3rd Ave # 300, Fort Lauderdale, FL 33316-2521 | 2019-01-24 |
| 1598272726 | Elizabeth Vukelich Austin | Physician Assistant | 1625 Se 3rd Ave # 723, Fort Lauderdale, FL 33316-2521 | 2018-01-09 |
| 1265805386 | Sandra Lynn Freymuth | Physician Assistant | 6211 Nw 34th Ave, Fort Lauderdale, FL 33309-1602 | 2015-11-11 |
| 1073526513 | Toribio Castillo | Physician Assistant | 6550 North Federal Highway, Ste 512, Fort Lauderdale, FL 33308-1417 | 2006-08-14 |
| 1023017704 | Kathy Ann Zimmer | Physician Assistant | 6550 N Federal Hwy, Suite 512, Fort Lauderdale, FL 33308-1404 | 2005-07-15 |
| 1780247189 | Oceanside Elite Surgical Assisting, LLC | Physician Assistant | 3319 Ne 15th Ct, Fort Lauderdale, FL 33304-1709 | 2019-04-21 |
| 1306321781 | Marissa Ziegler | Physician Assistant | 1995 E Oakland Park Blvd Ste 250, Fort Lauderdale, FL 33306-1149 | 2018-10-01 |
| 1205327749 | Priscila Marie Gamiotea | Physician Assistant | 3000 Bayview Dr, Fort Lauderdale, FL 33306-1772 | 2018-05-21 |
| 1518466333 | Andrew Michael Walters | Physician Assistant | 1995 E Oakland Park Blvd Ste 250, Fort Lauderdale, FL 33306-1149 | 2018-02-07 |
| 1235589334 | Dock and Roll LLC | Physician Assistant | 6211 Nw 34th Ave, Fort Lauderdale, FL 33309-1602 | 2016-06-20 |
| Find all providers in FORT LAUDERDALE | ||||
| City | FORT LAUDERDALE |
| Zip Code | 33312 |
Please comment or provide details below to improve the information on KELLIE LYNN DOMINESSY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.