Healthcare Provider Details

I. General information

NPI: 1629930565
Provider Name (Legal Business Name): KELSIE ANN RALSTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N BROAD STREET EXT
GROVE CITY PA
16127-4603
US

IV. Provider business mailing address

274 EVANS RD
ZELIENOPLE PA
16063-3010
US

V. Phone/Fax

Practice location:
  • Phone: 724-450-7010
  • Fax:
Mailing address:
  • Phone: 724-622-7598
  • Fax: 724-622-7598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP034509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: