Basic Information
| Provider Information | |||||||||
| NPI: | 1326399189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELSEY | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1057 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606363892 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1251 LEWIS RIVER RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WOODLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986749265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602254310 | ||||||||
| FaxNumber: | 3602254339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60299882 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.