Provider Demographics
NPI:1518098144
Name:ENNILA, KELSEY R (DC, DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:R
Last Name:ENNILA
Suffix:
Gender:M
Credentials:DC, DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 KALANIANAOLE HWY STE 114A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1281
Mailing Address - Country:US
Mailing Address - Phone:808-888-4800
Mailing Address - Fax:
Practice Address - Street 1:32 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2933
Practice Address - Country:US
Practice Address - Phone:808-934-9675
Practice Address - Fax:808-536-0320
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN3365363LF0000X, 363LF0000X
CADC29643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily