Provider Demographics
NPI:1821435041
Name:PAPPAS, KELSEY O, (MD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:O,
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 N FRESNO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4040
Mailing Address - Country:US
Mailing Address - Phone:559-222-9394
Mailing Address - Fax:
Practice Address - Street 1:4005 N FRESNO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4040
Practice Address - Country:US
Practice Address - Phone:559-222-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine