Provider Demographics
NPI:1447744438
Name:LEVAULT, KELSEY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:LEVAULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1304 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-9519
Mailing Address - Country:US
Mailing Address - Phone:217-321-9310
Mailing Address - Fax:217-692-2422
Practice Address - Street 1:1304 BURNETT DR
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-9519
Practice Address - Country:US
Practice Address - Phone:217-321-9310
Practice Address - Fax:217-692-2422
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125072817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine