Provider Demographics
NPI:1962874081
Name:PILCHER, KELSEY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PILCHER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 MEADOWLARK STREET
Mailing Address - Street 2:BLDG. 1053
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:29152-5019
Mailing Address - Country:US
Mailing Address - Phone:803-895-6550
Mailing Address - Fax:
Practice Address - Street 1:431 MEADOWLARK STREET
Practice Address - Street 2:BLDG. 1053
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:29152-5019
Practice Address - Country:US
Practice Address - Phone:803-895-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20734363LP0200X
TN203189163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse