Provider Demographics
NPI:1194471268
Name:BURKE, KELSY
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 E HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9771
Mailing Address - Country:US
Mailing Address - Phone:513-846-9091
Mailing Address - Fax:
Practice Address - Street 1:1693 E HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9771
Practice Address - Country:US
Practice Address - Phone:513-846-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker