Provider Demographics
NPI:1982258760
Name:OSMOND, KELSEY LANE (PPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LANE
Last Name:OSMOND
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0847
Mailing Address - Country:US
Mailing Address - Phone:307-272-6036
Mailing Address - Fax:
Practice Address - Street 1:125 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2409
Practice Address - Country:US
Practice Address - Phone:307-272-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
WYPPC-1209101Y00000X
WYLPC-2051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator