=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952897621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY RAE NEHRIG MPAS, PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2018
-----------------------------------------------------
Last Update Date | 07/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7420 SWITZER ROAD
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-574-0560
-----------------------------------------------------
Fax | 913-274-3499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7420 SWITZER ST
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66203-4550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-574-0560
-----------------------------------------------------
Fax | 913-274-3499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------