Provider Demographics
NPI:1114585122
Name:ELLIOTT, KELSEY DANIELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:DANIELLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:DANIELLE
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:722 MANN AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2909
Mailing Address - Country:US
Mailing Address - Phone:620-285-2105
Mailing Address - Fax:620-285-7236
Practice Address - Street 1:713 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4707
Practice Address - Country:US
Practice Address - Phone:620-792-3535
Practice Address - Fax:800-466-7923
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING152W00000X
KS2186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist