Provider Demographics
NPI:1750831129
Name:YORK, KELSEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:
Last Name:YORK
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 1:1415 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6136
Mailing Address - Country:US
Mailing Address - Phone:708-579-9375
Mailing Address - Fax:708-579-9378
Practice Address - Street 1:1415 W 47TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6136
Practice Address - Country:US
Practice Address - Phone:708-579-9375
Practice Address - Fax:708-579-9378
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant