Healthcare Provider Details

I. General information

NPI: 1578859526
Provider Name (Legal Business Name): KELSEY ECHOLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

2829 UNIVERSITY AVE SE STE 730
MINNEAPOLIS MN
55414-3279
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-6590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62488-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57544
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: