Healthcare Provider Details

I. General information

NPI: 1215964135
Provider Name (Legal Business Name): BETH MARIE KELSEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCHOOL OF NURSING BALL STATE UNIVERSITY
MUNCIE IN
47306-0265
US

IV. Provider business mailing address

3856 ELSTON HOCKSTOCK RD
BATAVIA OH
45103-3322
US

V. Phone/Fax

Practice location:
  • Phone: 765-285-5761
  • Fax: 765-285-2169
Mailing address:
  • Phone: 513-724-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number171676
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28074206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: