Healthcare Provider Details

I. General information

NPI: 1588461420
Provider Name (Legal Business Name): KELSEY VIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NORTH AVE
GRAND JUNCTION CO
81501-3122
US

IV. Provider business mailing address

1100 NORTH AVE
GRAND JUNCTION CO
81501-3122
US

V. Phone/Fax

Practice location:
  • Phone: 952-923-5564
  • Fax:
Mailing address:
  • Phone: 952-454-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: