Wagoner, Kelsey Anna

Wagoner, Kelsey Anna is an sole proprietor health care provider with primary practice located at 209 E Jefferson St , Plymouth IN 46563-1861. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wagoner, Kelsey Anna can be contacted via phone (574) 948-5100.

Contact Information

Primary practice address
209 E Jefferson St Plymouth IN 46563-1861
Phone: (574) 948-5100
Fax: (574) 335-0745
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71013346A Indiana

Profile Details

NPI number 1144941758
LBN Legal business name Wagoner, Kelsey Anna
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 12th, 2022
Last updated Nov 9th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144941758 NPPES
Indiana Other 1102690702 ANTHEM
Indiana MEDICAID 300070012 ANTHEM

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