Provider Demographics
NPI:1093365678
Name:FREEMAN, KELSEY ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:FREEMAN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:SHRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8417 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:CARLOCK
Mailing Address - State:IL
Mailing Address - Zip Code:61725-9668
Mailing Address - Country:US
Mailing Address - Phone:309-287-4869
Mailing Address - Fax:
Practice Address - Street 1:207 LANDMARK DR STE A
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3195
Practice Address - Country:US
Practice Address - Phone:309-268-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant