Provider Demographics
NPI:1346618998
Name:LEWIS, KELSEY NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:NICOLE
Other - Last Name:BUCKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3537
Mailing Address - Country:US
Mailing Address - Phone:785-229-8888
Mailing Address - Fax:785-229-8419
Practice Address - Street 1:424 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66092-8878
Practice Address - Country:US
Practice Address - Phone:785-883-4863
Practice Address - Fax:785-883-4038
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011038582363LF0000X
390200000X
KS53-77468363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program