Healthcare Provider Details

I. General information

NPI: 1417510082
Provider Name (Legal Business Name): KELSEY USSELMANN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 DE SOTO AVE APT 36420
WOODLAND HILLS CA
91367-0213
US

IV. Provider business mailing address

6200 DE SOTO AVE APT 36420
WOODLAND HILLS CA
91367-0213
US

V. Phone/Fax

Practice location:
  • Phone: 618-806-2996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: