Provider Demographics
NPI:1851086243
Name:KELSEY HOUSE, APRN LLC
Entity Type:Organization
Organization Name:KELSEY HOUSE, APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-989-8737
Mailing Address - Street 1:3065 TOWN TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4363
Mailing Address - Country:US
Mailing Address - Phone:239-989-7375
Mailing Address - Fax:239-215-1143
Practice Address - Street 1:3065 TOWN TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-4363
Practice Address - Country:US
Practice Address - Phone:239-989-7375
Practice Address - Fax:239-215-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty