Provider Demographics
NPI:1619529104
Name:FERRELL, KELSIE J (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KELSIE
Middle Name:J
Last Name:FERRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:J
Other - Last Name:BIAGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:12860 TROXLER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2898
Mailing Address - Country:US
Mailing Address - Phone:618-651-2810
Mailing Address - Fax:618-651-0077
Practice Address - Street 1:12860 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2898
Practice Address - Country:US
Practice Address - Phone:618-651-2810
Practice Address - Fax:618-651-0077
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019271363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily