Provider Demographics
NPI:1891333175
Name:DIMOND, KELSEY LYNN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:DIMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1327
Mailing Address - Country:US
Mailing Address - Phone:412-720-6296
Mailing Address - Fax:
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-623-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT176226163W00000X
CT9478367500000X
PARN672615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered