Provider Demographics
NPI:1134736432
Name:DANIELS, KELSEY MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MICHELLE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARKET PLACE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8717
Mailing Address - Country:US
Mailing Address - Phone:470-490-9600
Mailing Address - Fax:
Practice Address - Street 1:15 RIVERBEND DR SW STE 120
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6005
Practice Address - Country:US
Practice Address - Phone:706-622-9155
Practice Address - Fax:706-250-9948
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223700363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner