Provider Demographics
NPI:1780228262
Name:WOLFORD, KELSEY ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:655 IRVIN ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1217
Mailing Address - Country:US
Mailing Address - Phone:276-239-0195
Mailing Address - Fax:
Practice Address - Street 1:2617 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8271
Practice Address - Country:US
Practice Address - Phone:540-953-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-12-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant