MEDICARE: KELSEY SOUCY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CNP251564	ME

General Provider Information

NPI Number	:	1063393247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SOUCY FNP-C

Provider Business Mailing Address
First Line	:	18 GREEN HILL RD
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2810
Country	:	US
Telephone Number	:	207-764-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 GREEN HILL RD
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-2810
Country	:	US
Telephone Number	:	207-764-9406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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