Healthcare Provider Details

I. General information

NPI: 1124487574
Provider Name (Legal Business Name): JESSICA LYNNE KELSEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2016
Last Update Date: 02/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 E HIGH ST
SPRINGFIELD OH
45505-1225
US

IV. Provider business mailing address

1821 E HIGH ST
SPRINGFIELD OH
45505-1225
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-7340
  • Fax: 937-323-3363
Mailing address:
  • Phone: 937-323-7340
  • Fax: 937-323-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1115106
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCOA.18569-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: