Provider Demographics
NPI:1598470452
Name:DILLON, KELSI (PA-C)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CHINA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-1124
Mailing Address - Country:US
Mailing Address - Phone:740-586-5668
Mailing Address - Fax:
Practice Address - Street 1:712 CHINA ST
Practice Address - Street 2:
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731-1124
Practice Address - Country:US
Practice Address - Phone:740-586-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical