Provider Demographics
NPI:1699592402
Name:HERNANDEZ, KELSEY D'SHEA (RN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:D'SHEA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4958
Mailing Address - Country:US
Mailing Address - Phone:575-234-3305
Mailing Address - Fax:575-725-5999
Practice Address - Street 1:700 W STEVENS ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4958
Practice Address - Country:US
Practice Address - Phone:575-234-3305
Practice Address - Fax:575-725-5999
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64173163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool