Healthcare Provider Details

I. General information

NPI: 1265997522
Provider Name (Legal Business Name): KELSEY STARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E RUSSELL AVE STE A
WARRENSBURG MO
64093-9601
US

IV. Provider business mailing address

601 E RUSSELL AVE STE A
WARRENSBURG MO
64093-9601
US

V. Phone/Fax

Practice location:
  • Phone: 660-250-2442
  • Fax:
Mailing address:
  • Phone: 660-250-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2023025934
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: