Healthcare Provider Details

I. General information

NPI: 1568171486
Provider Name (Legal Business Name): KELSEY E FAIRCHILD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 METRO PL N
DUBLIN OH
43017-5342
US

IV. Provider business mailing address

1416 CHESAPEAKE AVENUE 1/2
COLUMBUS OH
43212
US

V. Phone/Fax

Practice location:
  • Phone: 855-289-1722
  • Fax:
Mailing address:
  • Phone: 419-509-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034369
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number501152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: