Provider Demographics
NPI:1598553661
Name:ECKERD, KELSEY MARIE (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:ECKERD
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Gender:
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 OLD WHITMORE AVE SE APT 326
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-1234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant