Provider Demographics
NPI:1245794304
Name:ADKINS, KELSEY ELISE
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:ELISE
Last Name:ADKINS
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 1:569 DOUGLAS FIR DR NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-8272
Mailing Address - Country:US
Mailing Address - Phone:616-205-6860
Mailing Address - Fax:
Practice Address - Street 1:1965 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8915
Practice Address - Country:US
Practice Address - Phone:616-457-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044598390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program