Provider Demographics
NPI:1609441674
Name:GARVIN, KELSAY BREANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELSAY
Middle Name:BREANN
Last Name:GARVIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELSAY
Other - Middle Name:
Other - Last Name:JENDRUSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:951 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-9799
Mailing Address - Country:US
Mailing Address - Phone:740-942-8638
Mailing Address - Fax:740-942-9052
Practice Address - Street 1:951 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9799
Practice Address - Country:US
Practice Address - Phone:740-942-8638
Practice Address - Fax:740-942-9052
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107733363LF0000X
OH0027875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily