Doctor Name: | MS. KELSEY MARIE HENNINGSON-KAYE |
NPI Number: | 1093976540 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2260-023 |
Business Practice Address: | 450 Eastvold Ave Ortonville Area Health Services/northside Medical Clini Ortonville, MN - 562781252 |
Business Phone Number: | 3208396157 |
Business Fax Number: | 3208393851 |
Mailing Address: | 450 Eastvold Ave, Ortonville Area Health Services/northside Medical Clini ORTONVILLE |
State: | MN |
Postal Code: | 56278 |
Phone Number: | 3208396157 |
Fax Number: | 3208393851 |
NPI Enumeration Date: | 06/18/2008 |
NPI Last Update Date: | 05/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2260-023 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |