MEDICARE: KELSEY DUTTON APRN

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	APRN11010996	FL

General Provider Information

NPI Number	:	1366031882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY DUTTON APRN

Provider Business Mailing Address
First Line	:	10719 EASTERN SHORE BLVD
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-6042
Country	:	US
Telephone Number	:	251-270-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10719 EASTERN SHORE BLVD
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-6042
Country	:	US
Telephone Number	:	251-270-0900
Fax Number	:

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

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	05/30/2023

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Directions to “ KELSEY DUTTON APRN” Practice Location

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