Provider Demographics
NPI:1235585001
Name:PURCELL, KELSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TOCCOAS TRL
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-1415
Mailing Address - Country:US
Mailing Address - Phone:419-360-2555
Mailing Address - Fax:
Practice Address - Street 1:185 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2404
Practice Address - Country:US
Practice Address - Phone:931-967-8200
Practice Address - Fax:931-967-8205
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical