Basic Information
| Provider Information | |||||||||
| NPI: | 1568017002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUEBLOOD | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270 | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474540270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127233944 | ||||||||
| FaxNumber: | 8127237989 | ||||||||
| Practice Location | |||||||||
| Address1: | 5604 E WHITE OAK LN | ||||||||
| Address2: | |||||||||
| City: | MARENGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471408413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123653221 | ||||||||
| FaxNumber: | 8123659502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2019 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71009289A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.