Provider Demographics
NPI:1548615834
Name:MOTHERSOLE, KELSEY HORTER (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:HORTER
Last Name:MOTHERSOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEANNE
Other - Last Name:HORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 W 34TH ST
Mailing Address - Street 2:STE 110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1202
Mailing Address - Country:US
Mailing Address - Phone:512-346-7600
Mailing Address - Fax:512-346-7603
Practice Address - Street 1:720 W 34TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1202
Practice Address - Country:US
Practice Address - Phone:512-346-7600
Practice Address - Fax:512-346-7603
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0577207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program