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General NPI Number Information
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NPI Number | 1265997522
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Entity Type | Individual
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Provider Name | KELSEY STARMAN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 601 E RUSSELL AVE STE A
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City | WARRENSBURG
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State | MO
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Zip | 64093-9601
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Country | US
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Telephone | 660-250-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 601 E RUSSELL AVE STE A
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City | WARRENSBURG
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State | MO
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Zip | 64093-9601
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Country | US
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Telephone | 660-250-2442
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Fax |
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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 | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2023025934
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License Number State | MO
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