Provider Demographics
NPI:1699541458
Name:HARRISON, KELSEY (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CROSS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4303
Mailing Address - Country:US
Mailing Address - Phone:248-928-6637
Mailing Address - Fax:
Practice Address - Street 1:32 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4303
Practice Address - Country:US
Practice Address - Phone:248-928-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant