Healthcare Provider Details

I. General information

NPI: 1376993477
Provider Name (Legal Business Name): KELSEY LEE HUGHES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY LEE OTTMANN

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MEDFORD RD
LAGRANGE ME
04453-5202
US

IV. Provider business mailing address

209 MEDFORD RD
LAGRANGE ME
04453-5202
US

V. Phone/Fax

Practice location:
  • Phone: 207-991-4801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: