Provider Demographics
NPI:1972119006
Name:KELSICK, KERN J (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KERN
Middle Name:J
Last Name:KELSICK
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1005
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8231
Mailing Address - Country:US
Mailing Address - Phone:832-808-0788
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1005
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8231
Practice Address - Country:US
Practice Address - Phone:281-888-0809
Practice Address - Fax:877-559-7682
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014398363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care