Provider Demographics
NPI:1821527250
Name:MCMULLEN, KELSEY RUTH (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:RUTH
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:RUTH
Other - Last Name:NEWBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1708 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2137
Mailing Address - Country:US
Mailing Address - Phone:518-344-4778
Mailing Address - Fax:
Practice Address - Street 1:1708 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2137
Practice Address - Country:US
Practice Address - Phone:518-344-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily