Provider Demographics
NPI:1235776949
Name:MICHAEL, KELSIE LEIGH
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:LEIGH
Last Name:MICHAEL
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 1:3986 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:CARPENTER
Mailing Address - State:WY
Mailing Address - Zip Code:82054-9105
Mailing Address - Country:US
Mailing Address - Phone:307-287-3128
Mailing Address - Fax:
Practice Address - Street 1:3986 PARADISE RD
Practice Address - Street 2:
Practice Address - City:CARPENTER
Practice Address - State:WY
Practice Address - Zip Code:82054-9105
Practice Address - Country:US
Practice Address - Phone:307-287-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare