Provider Demographics
NPI:1396438420
Name:TARVER, KELSIE LYNN
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:LYNN
Last Name:TARVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5143
Mailing Address - Country:US
Mailing Address - Phone:406-218-1416
Mailing Address - Fax:
Practice Address - Street 1:1035 SUMNER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5143
Practice Address - Country:US
Practice Address - Phone:406-218-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services