Provider Demographics
NPI:1023609617
Name:GERDEMAN, KELSI NIKOLE (FNP-C, ENP-C)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:NIKOLE
Last Name:GERDEMAN
Suffix:
Gender:F
Credentials:FNP-C, ENP-C
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:
Other - Last Name:LAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6504
Mailing Address - Country:US
Mailing Address - Phone:740-251-3552
Mailing Address - Fax:
Practice Address - Street 1:662 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9553
Practice Address - Country:US
Practice Address - Phone:937-641-5066
Practice Address - Fax:937-550-9797
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.414404163W00000X
OHAPRN.CNP.0028380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434572Medicaid