Provider Demographics
NPI:1972022549
Name:SORENSEN, KELSEY KAY (PA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:KAY
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:716 COUNTY ROAD 10 NE # 189
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 RESERVOIR AVE STE 203
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6043
Practice Address - Country:US
Practice Address - Phone:410-259-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant