Provider Demographics
NPI:1497069678
Name:HAMILTON, KELSEY MARIT (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIT
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:MARIT
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4825 OLSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-540-1837
Mailing Address - Fax:763-543-2420
Practice Address - Street 1:4825 OLSON MEMORIAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-540-1837
Practice Address - Fax:763-543-2420
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant