Provider Demographics
NPI:1508599424
Name:JEPSEN, KELSEY (NP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8578 AMAZON RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5510
Mailing Address - Country:US
Mailing Address - Phone:818-319-8192
Mailing Address - Fax:
Practice Address - Street 1:11100 WARNER AVE STE 368
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7514
Practice Address - Country:US
Practice Address - Phone:714-410-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021529363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics