Provider Demographics
NPI:1982366688
Name:NIETO, KELSEY JANET (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JANET
Last Name:NIETO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JANET
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16515 SE SLATE ST
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-9123
Mailing Address - Country:US
Mailing Address - Phone:503-481-8040
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4691
Practice Address - Country:US
Practice Address - Phone:907-562-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202109936NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily