Provider Demographics
NPI:1205485539
Name:FORTIN, KELSEY CAMPBELL (NP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CAMPBELL
Last Name:FORTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RENEA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:170 KEL KAT FARM LN
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401
Mailing Address - Country:US
Mailing Address - Phone:540-487-0768
Mailing Address - Fax:
Practice Address - Street 1:428 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3629
Practice Address - Country:US
Practice Address - Phone:540-949-8241
Practice Address - Fax:540-949-5582
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily