Healthcare Provider Details

I. General information

NPI: 1790312247
Provider Name (Legal Business Name): KELSEY REBECCA HURD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/20/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 8TH ST SW
ALTOONA IA
50009-1073
US

IV. Provider business mailing address

2001 8TH ST SW
ALTOONA IA
50009-1073
US

V. Phone/Fax

Practice location:
  • Phone: 515-577-2476
  • Fax:
Mailing address:
  • Phone: 515-577-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number105353
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: