MEDICARE: KELSEY NICOLE WRUBLE PA

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	7229	AZ
2	363AM0700X	Medical Physician Assistant	7229	AZ
3	363AS0400X	Surgical Physician Assistant	7229	AZ
4	207Q00000X	Family Medicine Physician	114	VI

General Provider Information

NPI Number	:	1851876577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY NICOLE WRUBLE PA

Provider Business Mailing Address
First Line	:	5000 ESTATE ENIGHED
Second Line	:
City	:	ST JOHN
State	:	VI
Zip	:	00830-6120
Country	:	US
Telephone Number	:	740-816-5332
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 ESTATE ENIGHED
Second Line	:
City	:	ST JOHN
State	:	VI
Zip	:	00830-6120
Country	:	US
Telephone Number	:	340-714-4270
Fax Number	:	888-979-9488

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	03/24/2025

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Directions to “ KELSEY NICOLE WRUBLE PA” Practice Location

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