Basic Information
Provider Information
NPI: 1306307038
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TEMPLEMAN
FirstName: KELSEY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2214 CANTERBURY DR STE 202
Address2:  
City: HAYS
State: KS
PostalCode: 676012375
CountryCode: US
TelephoneNumber: 7856232312
FaxNumber: 7856232323
Practice Location
Address1: 2214 CANTERBURY DR STE 202
Address2:  
City: HAYS
State: KS
PostalCode: 676012375
CountryCode: US
TelephoneNumber: 7856232312
FaxNumber: 7856232323
Other Information
ProviderEnumerationDate: 03/26/2019
LastUpdateDate: 09/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X1502164KSY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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