Provider Demographics
NPI:1518748896
Name:ROSSER, KELSEY WILKINS
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:WILKINS
Last Name:ROSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2975 BLACKFISH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3902
Mailing Address - Country:US
Mailing Address - Phone:843-425-5800
Mailing Address - Fax:
Practice Address - Street 1:3180 THOMASINA MCPHERSON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8283
Practice Address - Country:US
Practice Address - Phone:843-745-2184
Practice Address - Fax:843-745-2182
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC238865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse