Provider Demographics
NPI:1437626413
Name:RAGAN, KELSI SHAY (LVN)
Entity Type:Individual
Prefix:MISS
First Name:KELSI
Middle Name:SHAY
Last Name:RAGAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SHEA LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-7219
Mailing Address - Country:US
Mailing Address - Phone:208-821-2242
Mailing Address - Fax:
Practice Address - Street 1:809 SHEA LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-7219
Practice Address - Country:US
Practice Address - Phone:208-821-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344642164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse