Provider Demographics
NPI:1144476920
Name:KICLITER-KELLEY, DEBORAH ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:KICLITER-KELLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4825
Mailing Address - Country:US
Mailing Address - Phone:772-462-3800
Mailing Address - Fax:772-462-3865
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE B109
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-337-9473
Practice Address - Fax:772-337-0796
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198526363L00000X, 363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily