Healthcare Provider Details

I. General information

NPI: 1487010393
Provider Name (Legal Business Name): KELSEY HEATH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N9254 LAURA ST
APPLETON WI
54915-2898
US

IV. Provider business mailing address

N9254 LAURA ST
APPLETON WI
54915-2898
US

V. Phone/Fax

Practice location:
  • Phone: 920-944-2321
  • Fax: 920-944-2352
Mailing address:
  • Phone: 920-944-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14464-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: