Healthcare Provider Details

I. General information

NPI: 1609441674
Provider Name (Legal Business Name): KELSAY BREANN GARVIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSAY JENDRUSIK

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR STE 201
BARNESVILLE OH
43713-2000
US

IV. Provider business mailing address

100 HOSPITAL DR STE 201
BARNESVILLE OH
43713-2000
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-5150
  • Fax: 740-425-5152
Mailing address:
  • Phone: 740-425-5150
  • Fax: 740-425-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107733
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0027875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: