Provider Demographics
NPI:1538592316
Name:HISGHMAN, KALEY BROOKE (CAA)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:BROOKE
Last Name:HISGHMAN
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:BROOKE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4462 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4410
Mailing Address - Country:US
Mailing Address - Phone:912-687-2419
Mailing Address - Fax:
Practice Address - Street 1:2008 WHISPERING SANDS CT
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-6014
Practice Address - Country:US
Practice Address - Phone:912-687-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367H00000X
GA12548367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant