Provider Demographics
NPI:1467925594
Name:BELCOURT, KELSEY (FNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BELCOURT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-1387
Mailing Address - Country:US
Mailing Address - Phone:209-736-0249
Mailing Address - Fax:209-736-6724
Practice Address - Street 1:445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9328
Practice Address - Country:US
Practice Address - Phone:209-736-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789532163W00000X
CA95010968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse