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General NPI Number Information
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NPI Number | 1164815676
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Entity Type | Individual
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Provider Name | KELSEY HOUSE
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Gender | Female
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Dates
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Enumeration Date | 03/08/2015
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 3065 TOWN TER
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City | NORTH PORT
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State | FL
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Zip | 34286-4363
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Country | US
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Telephone | 239-989-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 1498 PACIFIC AVE STE 400
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City | TACOMA
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State | WA
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Zip | 98402-4208
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Country | US
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Telephone | 855-768-6363
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Fax | 253-682-1714
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP9268237
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704318096
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License Number State | MI
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