Provider Demographics
NPI:1508397837
Name:RIEMENSCHNEIDER, KELSIE J (MD)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:J
Last Name:RIEMENSCHNEIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W ARAPAHO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4154
Mailing Address - Country:US
Mailing Address - Phone:214-833-5300
Mailing Address - Fax:
Practice Address - Street 1:702 W ARAPAHO RD STE 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4154
Practice Address - Country:US
Practice Address - Phone:214-833-5300
Practice Address - Fax:972-634-6349
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9649207N00000X
NH33590207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN64937OtherTN LICENSE