Provider Demographics
NPI:1720859267
Name:COLLINS, KELSEY MARIE
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:CLAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4709 LANAI WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1207
Mailing Address - Country:US
Mailing Address - Phone:847-220-2680
Mailing Address - Fax:
Practice Address - Street 1:4709 LANAI WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-1207
Practice Address - Country:US
Practice Address - Phone:847-220-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95139914163WC0200X
CA95002550367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine