Healthcare Provider Details

I. General information

NPI: 1891614616
Provider Name (Legal Business Name): KELSI EVE MAGNUSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 MORGANTON RD STE 101
FAYETTEVILLE NC
28314-1525
US

IV. Provider business mailing address

313 MCKENZIE RD APT H
SPRING LAKE NC
28390-3587
US

V. Phone/Fax

Practice location:
  • Phone: 910-551-1670
  • Fax: 910-491-0335
Mailing address:
  • Phone: 910-551-1670
  • Fax: 910-491-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: