Healthcare Provider Details

I. General information

NPI: 1568035236
Provider Name (Legal Business Name): KELSEY OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S DOUGLAS HWY STE 120
GILLETTE WY
82718-5408
US

IV. Provider business mailing address

PO BOX 6850
RAPID CITY SD
57709-6850
US

V. Phone/Fax

Practice location:
  • Phone: 800-446-9556
  • Fax: 605-341-7062
Mailing address:
  • Phone: 605-341-1414
  • Fax: 605-341-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number48562
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: