Provider Demographics
NPI:1932296449
Name:BEISEL, KELLY ANN (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:BEISEL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2336
Mailing Address - Country:US
Mailing Address - Phone:315-735-2294
Mailing Address - Fax:315-735-2021
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2336
Practice Address - Country:US
Practice Address - Phone:315-735-2294
Practice Address - Fax:315-735-2021
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010189-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370743Medicaid
NY03370743Medicaid