Provider Demographics
NPI:1659716652
Name:VINSON, KELSI JEAN (CST, CSFA)
Entity Type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:JEAN
Last Name:VINSON
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 MARY JO AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-4162
Mailing Address - Country:US
Mailing Address - Phone:850-276-0662
Mailing Address - Fax:
Practice Address - Street 1:7318 MARY JO AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409-4162
Practice Address - Country:US
Practice Address - Phone:850-276-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL141323246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant