Provider Demographics
NPI:1528778404
Name:DOVELL, KELSEY JEAN (NP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JEAN
Last Name:DOVELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:430 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1430
Mailing Address - Country:US
Mailing Address - Phone:774-766-7634
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2455
Practice Address - Country:US
Practice Address - Phone:508-624-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2309337163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency