Provider Demographics
NPI:1881037679
Name:ALEXANDER, KELSEY JANE (PAC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JANE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JANE
Other - Last Name:SLETTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6565 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2141
Mailing Address - Country:US
Mailing Address - Phone:952-920-0866
Mailing Address - Fax:
Practice Address - Street 1:6565 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2141
Practice Address - Country:US
Practice Address - Phone:952-920-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical