Healthcare Provider Details

I. General information

NPI: 1184592958
Provider Name (Legal Business Name): COURTNEY KELSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY H GROSS

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 01/17/2026
Certification Date: 01/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

489 STATE ST
BANGOR ME
04401-6616
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP261052
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN84115
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: