Provider Demographics
NPI:1962967711
Name:WOYCIK, KELSEY R (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:R
Last Name:WOYCIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELSSEY
Other - Middle Name:RAE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:541 SUNSET LN STE 103
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3903
Practice Address - Country:US
Practice Address - Phone:540-321-3002
Practice Address - Fax:540-829-0019
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962967711Medicaid