MEDICARE: KELSEY HOUSE

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	60221	NM

General Provider Information

NPI Number	:	1558210005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY HOUSE

Provider Business Mailing Address
First Line	:	7560 VISTA DE OESTE PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0786
Country	:	US
Telephone Number	:	575-495-9765
Fax Number	:

Provider Business Practice Location Address
First Line	:	7560 VISTA DE OESTE PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0786
Country	:	US
Telephone Number	:	575-495-9765
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ KELSEY HOUSE ” Practice Location

Language	Start Address	Practice Location

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