Provider Demographics
NPI:1578512000
Name:KUEHN, KELSY LENORE (PAC)
Entity Type:Individual
Prefix:MS
First Name:KELSY
Middle Name:LENORE
Last Name:KUEHN
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1661 SAINT ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3733
Practice Address - Country:US
Practice Address - Phone:651-968-5300
Practice Address - Fax:651-646-0205
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN388037100Medicaid
MN388037100Medicaid
MNH400211004Medicare PIN