Provider Demographics
NPI:1801540869
Name:CREEL, KELSEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CREEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9481 CADE LN
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9314
Mailing Address - Country:US
Mailing Address - Phone:601-616-9825
Mailing Address - Fax:
Practice Address - Street 1:9481 CADE LN
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MS
Practice Address - Zip Code:39320-9314
Practice Address - Country:US
Practice Address - Phone:601-616-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner