Provider Demographics
NPI:1922682780
Name:FERRIS, KELSEY TOLBERT (MD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:TOLBERT
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1401 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2705
Mailing Address - Country:US
Mailing Address - Phone:307-672-1000
Mailing Address - Fax:
Practice Address - Street 1:1401 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2705
Practice Address - Country:US
Practice Address - Phone:307-672-1000
Practice Address - Fax:307-672-1010
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WY18650A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program