Provider Demographics
NPI:1609364785
Name:STAPLETON, KELSEY ELISABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELISABETH
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ELISABETH
Other - Last Name:GRIFFITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:631 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-676-3870
Practice Address - Fax:276-628-8927
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3586363A00000X
VA0110006122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant