Provider Demographics
NPI:1356664262
Name:KELSO, LAURA ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:KELSO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7914
Mailing Address - Country:US
Mailing Address - Phone:270-441-4200
Mailing Address - Fax:270-441-4982
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-5880
Practice Address - Fax:270-538-5870
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY6389P363L00000X
KY3006389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100117090Medicaid
KY0257938Medicare PIN