Provider Demographics
NPI:1740737634
Name:ALLEN, KELSI DIANNE (MAPS, PAC)
Entity Type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:DIANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MAPS, PAC
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:DIANNE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAPS, PAC
Mailing Address - Street 1:1520 S 70TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1566
Mailing Address - Country:US
Mailing Address - Phone:402-464-9000
Mailing Address - Fax:402-464-4447
Practice Address - Street 1:1520 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1566
Practice Address - Country:US
Practice Address - Phone:402-464-9000
Practice Address - Fax:402-464-4447
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant