Provider Demographics
NPI:1902658826
Name:WATCHORN, KELSEY DAWN (PLIMHP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:DAWN
Last Name:WATCHORN
Suffix:
Gender:F
Credentials:PLIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 POLE CREEK XING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2901
Mailing Address - Country:US
Mailing Address - Phone:308-254-8736
Mailing Address - Fax:
Practice Address - Street 1:1000 POLE CREEK XING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2901
Practice Address - Country:US
Practice Address - Phone:308-254-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health