Provider Demographics
NPI:1427666320
Name:ABRAHAM, KELSEY KAY (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:KAY
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1527
Mailing Address - Country:US
Mailing Address - Phone:612-380-5995
Mailing Address - Fax:612-474-9350
Practice Address - Street 1:335 MAIN ST S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1527
Practice Address - Country:US
Practice Address - Phone:612-380-5995
Practice Address - Fax:612-474-9350
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174546OtherNCCPA