Healthcare Provider Details

I. General information

NPI: 1598251209
Provider Name (Legal Business Name): KELSEY RENE MORTON AGACNP-BC FNP-BC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

652 FM 31 S
CARTHAGE TX
75633-4314
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-0351
  • Fax: 903-535-9217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP10122
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP138135
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10122
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: