Provider Demographics
NPI:1962069716
Name:FOURNIER, KELSIE RAE (PA-C)
Entity type:Individual
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First Name:KELSIE
Middle Name:RAE
Last Name:FOURNIER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:380 COUNTY ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4504
Mailing Address - Country:US
Mailing Address - Phone:518-483-2600
Mailing Address - Fax:
Practice Address - Street 1:380 COUNTY ROUTE 51
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4504
Practice Address - Country:US
Practice Address - Phone:518-483-2600
Practice Address - Fax:518-483-0115
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2021-10-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant