Provider Demographics
NPI:1811502156
Name:CARDINAL, KELSEY LAURANNE (CRNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LAURANNE
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 HILLCREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4232
Mailing Address - Country:US
Mailing Address - Phone:334-414-1661
Mailing Address - Fax:
Practice Address - Street 1:8611 HILLCREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4232
Practice Address - Country:US
Practice Address - Phone:214-692-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158582363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health