Provider Demographics
NPI:1518553940
Name:ROBERTS, KELSI
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ERSKINE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-7842
Mailing Address - Country:US
Mailing Address - Phone:681-235-7000
Mailing Address - Fax:681-235-7001
Practice Address - Street 1:33 ERSKINE LN
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-7842
Practice Address - Country:US
Practice Address - Phone:681-235-7000
Practice Address - Fax:681-235-7001
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant