Provider Demographics
NPI:1871949446
Name:PAYSEN, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PAYSEN
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 1:1309 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5243
Mailing Address - Country:US
Mailing Address - Phone:563-243-6641
Mailing Address - Fax:563-243-8354
Practice Address - Street 1:1309 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5243
Practice Address - Country:US
Practice Address - Phone:563-243-6641
Practice Address - Fax:563-243-8354
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist