Provider Demographics
NPI:1922440403
Name:KELSEY, JO (FNP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:KELSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15791 W MAUI LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6274
Mailing Address - Country:US
Mailing Address - Phone:623-262-0639
Mailing Address - Fax:
Practice Address - Street 1:10249 W THUNDERBIRD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3113
Practice Address - Country:US
Practice Address - Phone:623-262-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP5041261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care