Provider Demographics
NPI:1205575362
Name:VANVORST, KELSEY LYNN (LPN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:VANVORST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:LYNN
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:66 AHL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-2964
Mailing Address - Country:US
Mailing Address - Phone:518-713-8387
Mailing Address - Fax:
Practice Address - Street 1:12 TOWPATH LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12065-1220
Practice Address - Country:US
Practice Address - Phone:518-713-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328670-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse