Healthcare Provider Details

I. General information

NPI: 1366951261
Provider Name (Legal Business Name): KELSEA HOPKINS PA-C MS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15605 E SPRAGUE AVE
SPOKANE VALLEY WA
99037-8901
US

IV. Provider business mailing address

15605 E SPRAGUE AVE
SPOKANE VALLEY WA
99037-8901
US

V. Phone/Fax

Practice location:
  • Phone: 509-598-7820
  • Fax:
Mailing address:
  • Phone: 509-598-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1206904
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86081622
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: