Provider Demographics
NPI:1841879103
Name:KELSO, CYNTHIA (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KELSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 MORROW CREST DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7299
Mailing Address - Country:US
Mailing Address - Phone:901-216-4374
Mailing Address - Fax:
Practice Address - Street 1:1070 MORROW CREST DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-7299
Practice Address - Country:US
Practice Address - Phone:901-216-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily