Provider Demographics
NPI:1083155576
Name:ARSHAD, KELSEY TUCKER (DNP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:TUCKER
Last Name:ARSHAD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BOGUS HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2801
Mailing Address - Country:US
Mailing Address - Phone:203-417-1397
Mailing Address - Fax:
Practice Address - Street 1:27 BOGUS HILL RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-2801
Practice Address - Country:US
Practice Address - Phone:203-417-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308075-1363L00000X
CT6939363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner