Provider Demographics
NPI:1700555331
Name:UNDERWOOD, KELSEY (FNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ROGNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-9010
Mailing Address - Country:US
Mailing Address - Phone:715-284-4311
Mailing Address - Fax:
Practice Address - Street 1:610 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-9110
Practice Address - Country:US
Practice Address - Phone:715-284-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11263-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner