Provider Demographics
NPI:1760158620
Name:CELESTE, KELSEY MARIE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:CELESTE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:CELESTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:199 HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1604
Mailing Address - Country:US
Mailing Address - Phone:518-222-6965
Mailing Address - Fax:
Practice Address - Street 1:391 MYRTLE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3797
Practice Address - Country:US
Practice Address - Phone:518-262-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383298363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics