MEDICARE: MRS. KELSEY CLOUD MSN, APRN, FNP-BC

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	163W00000X	Registered Nurse	RN.389340	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0037664	OH

General Provider Information

NPI Number	:	1962229229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSEY CLOUD MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 637736
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7736
Country	:	US
Telephone Number	:	513-891-1006
Fax Number	:	513-793-1032

Provider Business Practice Location Address
First Line	:	1092 JEFFERSON ST
Second Line	:
City	:	GREENFIELD
State	:	OH
Zip	:	45123-8319
Country	:	US
Telephone Number	:	937-981-1121
Fax Number	:	937-981-5660

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	10/06/2024

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