Provider Demographics
NPI:1881361772
Name:LANCE, KELSEY PANTER
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:PANTER
Last Name:LANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 DEEP SOUTH FARM RD STE A
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2218
Mailing Address - Country:US
Mailing Address - Phone:706-745-9417
Mailing Address - Fax:706-896-0877
Practice Address - Street 1:4799 BLUE RIDGE DR STE 104
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-3468
Practice Address - Country:US
Practice Address - Phone:706-632-1155
Practice Address - Fax:706-896-0877
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty