Provider Demographics
NPI:1265266126
Name:MCKINLEY, KELSEY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4106 N 172ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3041
Mailing Address - Country:US
Mailing Address - Phone:402-238-5366
Mailing Address - Fax:
Practice Address - Street 1:11810 NICHOLAS ST STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4453
Practice Address - Country:US
Practice Address - Phone:402-401-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine