Provider Demographics
NPI:1952022030
Name:FRESHOUR, KELSEY TAYLOR (RN, BSN, MSN, CPNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:TAYLOR
Last Name:FRESHOUR
Suffix:
Gender:F
Credentials:RN, BSN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 NE 81ST TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1168
Mailing Address - Country:US
Mailing Address - Phone:816-792-1170
Mailing Address - Fax:816-792-3877
Practice Address - Street 1:9051 NE 81ST TER STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1168
Practice Address - Country:US
Practice Address - Phone:816-792-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030125363LP0200X
KS53-80887-041363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics