Provider Demographics
NPI:1558956532
Name:MEADOWS, KELSI
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:MEADOWS
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:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:LASHMEET
Mailing Address - State:WV
Mailing Address - Zip Code:24733-0436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2243 CLINES COUNTRY RD
Practice Address - Street 2:
Practice Address - City:LASHMEET
Practice Address - State:WV
Practice Address - Zip Code:24733
Practice Address - Country:US
Practice Address - Phone:304-952-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker