Provider Demographics
NPI:1609392687
Name:KROSTING, KELSEY LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:LEE
Last Name:KROSTING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:LEE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73265 CONFEDERATED WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9099
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:541-278-7568
Practice Address - Street 1:73265 CONFEDERATED WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9099
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-278-7568
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201705798RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse