Provider Demographics
NPI:1871968917
Name:CARNAHAN, KELSIE
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:CARNAHAN
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 1:300 W PIER DR
Mailing Address - Street 2:APT 146 C
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1870
Mailing Address - Country:US
Mailing Address - Phone:419-439-2464
Mailing Address - Fax:
Practice Address - Street 1:300 W PIER DR
Practice Address - Street 2:APT 146 C
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1870
Practice Address - Country:US
Practice Address - Phone:419-439-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information