Provider Demographics
NPI:1831638246
Name:LOPEZ, KELSEY CATHCART (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:CATHCART
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANNE
Other - Last Name:CATHCART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3031 S 116 RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-5125
Mailing Address - Country:US
Mailing Address - Phone:925-323-2854
Mailing Address - Fax:
Practice Address - Street 1:3031 S 116 RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-5125
Practice Address - Country:US
Practice Address - Phone:925-323-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0128086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily