Provider Demographics
NPI:1093338170
Name:ANTLE, KELSEY NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:NICOLE
Last Name:ANTLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1000 JAMES F EPPS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7354
Mailing Address - Country:US
Mailing Address - Phone:417-334-7291
Mailing Address - Fax:417-334-6156
Practice Address - Street 1:1000 JAMES F EPPS RD STE 1
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7354
Practice Address - Country:US
Practice Address - Phone:417-334-7291
Practice Address - Fax:417-334-6156
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020013708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist