Provider Demographics
NPI:1316740038
Name:EWING, KELSEY JOY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JOY
Last Name:EWING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 15TH AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3822
Mailing Address - Country:US
Mailing Address - Phone:308-641-9806
Mailing Address - Fax:
Practice Address - Street 1:1016 15TH AVE APT 119
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3822
Practice Address - Country:US
Practice Address - Phone:308-641-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider