Provider Demographics
NPI:1629048897
Name:KELSEY, JAN (RN)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3906
Mailing Address - Country:US
Mailing Address - Phone:719-238-0117
Mailing Address - Fax:719-268-1711
Practice Address - Street 1:1130 EAGLE ROCK RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3906
Practice Address - Country:US
Practice Address - Phone:719-238-0117
Practice Address - Fax:719-268-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00114259163WC0400X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WC0400XNursing Service ProvidersRegistered NurseCase Management