Provider Demographics
NPI:1780281675
Name:DEGARMO, KELSA MARIE (PA)
Entity type:Individual
Prefix:
First Name:KELSA
Middle Name:MARIE
Last Name:DEGARMO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELSA
Other - Middle Name:M
Other - Last Name:DIDIER-MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1803
Mailing Address - Country:US
Mailing Address - Phone:402-476-1455
Mailing Address - Fax:
Practice Address - Street 1:1021 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1803
Practice Address - Country:US
Practice Address - Phone:402-476-1455
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007970363A00000X
NE2535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant