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General NPI Number Information
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NPI Number | 1669292868
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Entity Type | Individual
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Provider Name | KELSEY NICOLE ANDERSON PA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 1318 KANSAS DR
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City | PAOLA
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State | KS
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Zip | 66071-2107
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Country | US
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Telephone | 913-557-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 3909 W 141ST DR
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City | LEAWOOD
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State | KS
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Zip | 66224-9714
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Country | US
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Telephone | 913-522-5670
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 15-02998
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License Number State | KS
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