Provider Demographics
NPI:1235823840
Name:DESROCHES, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DESROCHES
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 1:103 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1512
Mailing Address - Country:US
Mailing Address - Phone:781-255-0500
Mailing Address - Fax:
Practice Address - Street 1:103 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:EAST WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02032-1512
Practice Address - Country:US
Practice Address - Phone:781-255-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant