MEDICARE: MRS. KENNIE I KOELSCH MSN, ACNP-BC, CRNP

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	363LA2100X	Acute Care Nurse Practitioner	0024171146	VA
2	363LA2100X	Acute Care Nurse Practitioner	SP009837	PA

General Provider Information

NPI Number	:	1174764658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENNIE I KOELSCH MSN, ACNP-BC, CRNP

Provider Business Mailing Address
First Line	:	1906 BELLEVIEW AVE SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-1838
Country	:	US
Telephone Number	:	540-728-0298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2726 ELECTRIC RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3528
Country	:	US
Telephone Number	:	540-772-4448
Fax Number	:	540-772-0410

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

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	02/11/2026

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