Provider Demographics
NPI:1740727809
Name:TWO BEARS, KELSEY M (PA)
Entity type:Individual
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First Name:KELSEY
Middle Name:M
Last Name:TWO BEARS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:MCN PRIMARY CLINICS
Mailing Address - Street 2:DEPT # 1467
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 W FORREST AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3249
Practice Address - Country:US
Practice Address - Phone:918-689-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant