Healthcare Provider Details

I. General information

NPI: 1760190979
Provider Name (Legal Business Name): KELSIE JOY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSIE D'AOUST APRN

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NEBRASKA AVE STE 9
FORT PIERCE FL
34950-4837
US

IV. Provider business mailing address

5744 SE EDGEWATER CIR
STUART FL
34997-3501
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-4757
  • Fax:
Mailing address:
  • Phone: 561-313-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN285752
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9616534
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11035829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: