MEDICARE: MRS. KELSI JEAN VINSON CST, CSFA

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	246ZC0007X	Surgical Assistant	141323	FL

General Provider Information

NPI Number	:	1659716652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSI JEAN VINSON CST, CSFA

Provider Business Mailing Address
First Line	:	7318 MARY JO AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-4162
Country	:	US
Telephone Number	:	850-276-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	7318 MARY JO AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-4162
Country	:	US
Telephone Number	:	850-276-0662
Fax Number	:

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

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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