Provider Demographics
NPI:1619208881
Name:YEOMANS, KELSEY B (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:B
Last Name:YEOMANS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:B
Other - Last Name:GRABOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:550 W WESTERN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1045
Mailing Address - Country:US
Mailing Address - Phone:231-726-4498
Mailing Address - Fax:231-726-4468
Practice Address - Street 1:550 W WESTERN AVE
Practice Address - Street 2:STE B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1045
Practice Address - Country:US
Practice Address - Phone:231-726-4498
Practice Address - Fax:231-726-4468
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235759367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered