Provider Demographics
NPI:1437547346
Name:ALT, KELSEY JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JO
Last Name:ALT
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 1:895 WASHINGTON ST SW
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-1067
Mailing Address - Country:US
Mailing Address - Phone:540-231-5350
Mailing Address - Fax:540-231-7473
Practice Address - Street 1:895 WASHINGTON ST SW
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-3011
Practice Address - Country:US
Practice Address - Phone:540-231-6444
Practice Address - Fax:540-231-7473
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01856363A00000X
VA0110004767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant