Provider Demographics
NPI:1376993477
Name:HUGHES, KELSEY LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:LEE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEE
Other - Last Name:OTTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 MEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:ME
Mailing Address - Zip Code:04453-5202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 MEDFORD RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:ME
Practice Address - Zip Code:04453-5202
Practice Address - Country:US
Practice Address - Phone:207-991-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant