Provider Demographics
NPI:1467171165
Name:CASEY, KELSEY LYN (ACNPC-AG)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:LYN
Last Name:CASEY
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9512
Mailing Address - Country:US
Mailing Address - Phone:740-808-6268
Mailing Address - Fax:
Practice Address - Street 1:751 FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2875
Practice Address - Country:US
Practice Address - Phone:740-455-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031741363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty