Provider Demographics
NPI:1124487574
Name:KELSEY, JESSICA LYNNE (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:KELSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1225
Mailing Address - Country:US
Mailing Address - Phone:937-323-7340
Mailing Address - Fax:937-323-3363
Practice Address - Street 1:1821 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1225
Practice Address - Country:US
Practice Address - Phone:937-323-7340
Practice Address - Fax:937-323-3363
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1115106363LF0000X
OHCOA.18569-NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily