Provider Demographics
NPI:1902824766
Name:KELSOR, PAULA MAE (R)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MAE
Last Name:KELSOR
Suffix:
Gender:F
Credentials:R
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1548 GOLF FOREST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-6626
Mailing Address - Country:US
Mailing Address - Phone:904-766-8956
Mailing Address - Fax:
Practice Address - Street 1:1699 S 14TH ST
Practice Address - Street 2:STE 16
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1963
Practice Address - Country:US
Practice Address - Phone:904-491-7700
Practice Address - Fax:904-491-7701
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL63980247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist