Healthcare Provider Details

I. General information

NPI: 1770492282
Provider Name (Legal Business Name): KELSEY PERSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HIGHWAY 50
GILLETTE WY
82718-9330
US

IV. Provider business mailing address

6800 FORCE RD
GILLETTE WY
82718-4101
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-1204
  • Fax:
Mailing address:
  • Phone: 307-299-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59347
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: