MEDICARE: KELSEY MCMAHON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2053	NE

General Provider Information

NPI Number	:	1538614763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MCMAHON

Provider Business Mailing Address
First Line	:	2207 OSBORNE DR W
Second Line	:	SUITE 100
City	:	HASTINGS
State	:	NE
Zip	:	68901-9112
Country	:	US
Telephone Number	:	402-462-2139
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 S 17TH ST STE 310
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68502-3700
Country	:	US
Telephone Number	:	402-483-8555
Fax Number	:	402-483-8554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	12/28/2022

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Directions to “ KELSEY MCMAHON ” Practice Location

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