Provider Demographics
NPI:1992409478
Name:FULDA, KELSI (FNP-C)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:FULDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2612
Mailing Address - Country:US
Mailing Address - Phone:765-660-7330
Mailing Address - Fax:
Practice Address - Street 1:330 N WABASH AVE STE 210
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2679
Practice Address - Country:US
Practice Address - Phone:765-660-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28212485A163W00000X
IN71013807A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse