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General NPI Number Information
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NPI Number | 1851876577
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Entity Type | Individual
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Provider Name | KELSEY NICOLE WRUBLE PA
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Gender | Female
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 5000 ESTATE ENIGHED
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City | ST JOHN
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State | VI
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Zip | 00830-6120
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Country | US
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Telephone | 340-714-4270
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Fax | 888-979-9488
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Provider Business Mailing Address
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Address Line | 5000 ESTATE ENIGHED
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City | ST JOHN
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State | VI
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Zip | 00830-6120
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Country | US
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Telephone | 740-816-5332
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7229
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7229
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7229
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 114
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License Number State | VI
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