Provider Demographics
NPI:1992283899
Name:ARNOLD, KELSEY (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 E GEORGIA ST APT 147
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3903
Mailing Address - Country:US
Mailing Address - Phone:586-322-8242
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST STE 604
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-629-5633
Practice Address - Fax:502-629-5580
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002537A363A00000X
363AS0400X
KYTC008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical