Healthcare Provider Details

I. General information

NPI: 1528699980
Provider Name (Legal Business Name): KELSEY SANDERS VASON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 DANTIGNAC ST
AUGUSTA GA
30901-2788
US

IV. Provider business mailing address

1226 DANTIGNAC ST
AUGUSTA GA
30901-2788
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax: 706-922-0604
Mailing address:
  • Phone: 706-922-0600
  • Fax: 706-922-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN255257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: