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NPI Code Detail

MEDICARE: KELSEY MUMMERT

MEDICARE: KELSEY MUMMERT
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
1363LP0222XCritical Care Pediatric Nurse PractitionerPENDINGTX

General Provider Information

NPI Number : 1922639574
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY MUMMERT
Provider Business Mailing Address
First Line : 3811 INTERLAKE AVE N UNIT B
Second Line :
City : SEATTLE
State : WA
Zip : 98103-8129
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6621 FANNIN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2358
Country : US
Telephone Number : 832-824-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2020
Last Update Date : 02/03/2020

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Directions to “ KELSEY MUMMERT ” Practice Location

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