Provider Demographics
NPI:1619479698
Name:ADLER, KAELYSE NOEL (PA-C)
Entity Type:Individual
Prefix:
First Name:KAELYSE
Middle Name:NOEL
Last Name:ADLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0431
Mailing Address - Country:US
Mailing Address - Phone:308-432-4441
Mailing Address - Fax:308-432-2130
Practice Address - Street 1:412 W 42ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2401
Practice Address - Country:US
Practice Address - Phone:308-865-2303
Practice Address - Fax:308-865-2304
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2217OtherNEBRASKA STATE LICENSE (PA-C)