Healthcare Provider Details

I. General information

NPI: 1487010393
Provider Name (Legal Business Name): KELSEY HEATH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HIGHWAY 49, STE 1900
BYRON GA
31008
US

IV. Provider business mailing address

212 HIGHWAY 49, STE 1900
BYRON GA
31008
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-3552
  • Fax:
Mailing address:
  • Phone: 478-238-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14464-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: