Healthcare Provider Details

I. General information

NPI: 1720145063
Provider Name (Legal Business Name): KELSEY GERARD JAMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WINCHESTER AVE
ASHLAND KY
41101-7743
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-7351
  • Fax: 606-324-7359
Mailing address:
  • Phone: 606-324-7351
  • Fax: 606-324-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37818
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: