Provider Demographics
NPI:1578373627
Name:BLAIS, KELSEY (RN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BLAIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44506 156TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SD
Mailing Address - Zip Code:57235-5111
Mailing Address - Country:US
Mailing Address - Phone:605-881-7119
Mailing Address - Fax:
Practice Address - Street 1:4 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3936
Practice Address - Country:US
Practice Address - Phone:605-884-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR049945163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice