Provider Demographics
NPI:1386896090
Name:HOTT, KELSEY RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RENEE
Last Name:HOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RENEE
Other - Last Name:MEADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:721 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054-1633
Mailing Address - Country:US
Mailing Address - Phone:304-822-3838
Mailing Address - Fax:304-822-7665
Practice Address - Street 1:721 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-1633
Practice Address - Country:US
Practice Address - Phone:620-723-2127
Practice Address - Fax:620-723-1037
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant