Healthcare Provider Details

I. General information

NPI: 1609364785
Provider Name (Legal Business Name): KELSEY ELISABETH STAPLETON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY ELISABETH GRIFFITTS

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 10/31/2021
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CAMPUS DR
ABINGDON VA
24210-9700
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-3870
  • Fax: 276-628-8927
Mailing address:
  • Phone: 423-857-2093
  • Fax: 423-390-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3586
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: