Provider Demographics
NPI:1114681889
Name:BAUER, KELSEY NICOLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICOLE
Last Name:BAUER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89190 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:NE
Mailing Address - Zip Code:68736-3013
Mailing Address - Country:US
Mailing Address - Phone:402-640-9888
Mailing Address - Fax:
Practice Address - Street 1:3500 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3203
Practice Address - Country:US
Practice Address - Phone:800-472-9018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG166049363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health