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General NPI Number Information
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NPI Number | 1982528998
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Entity Type | Individual
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Provider Name | KELSEY RENAY FULLERTON PNP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 21 N 12TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-5161
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Country | US
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Telephone | 913-342-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 SE SCENIC DR
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-4234
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Country | US
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Telephone | 816-377-3999
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 53-85966-101
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License Number State | KS
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