Provider Demographics
NPI:1215964135
Name:KELSEY, BETH MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARIE
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 1:3856 ELSTON HOCKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3322
Mailing Address - Country:US
Mailing Address - Phone:513-724-1035
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL OF NURSING
Practice Address - Street 2:BALL STATE UNIVERSITY
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0265
Practice Address - Country:US
Practice Address - Phone:765-285-5761
Practice Address - Fax:765-285-2169
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171676363LW0102X
IN28074206A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76135250Medicaid