Provider Demographics
NPI:1639918063
Name:BADER, KELSEY BRIANNA (RN)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:BRIANNA
Last Name:BADER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:BRIANNA
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10518 COOPER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-7853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10518 COOPER LAKE RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-7853
Practice Address - Country:US
Practice Address - Phone:318-737-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95355895163W00000X
DCRN500014188163W00000X
AK215197163W00000X
NV867875163W00000X
RIRN78781163W00000X
MN2521658163W00000X
MI4704404298163W00000X
IL041560452163W00000X
HIRN-114783163W00000X
OR10018544163W00000X
MARN2391511163W00000X
LA201485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse