Provider Demographics
NPI:1124345103
Name:NYLANDER, KELSEY RAYE (DO)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:RAYE
Last Name:NYLANDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:RAYE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1420 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1532
Mailing Address - Country:US
Mailing Address - Phone:605-717-8595
Mailing Address - Fax:605-642-8618
Practice Address - Street 1:1420 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783
Practice Address - Country:US
Practice Address - Phone:605-717-8595
Practice Address - Fax:605-642-8618
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine