Individual
KELLIE NICOLE NANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
REGIONS HOSPITAL, 640 JACKSON STREET MS11102F, ST. PAUL, MN 55101-2502
(952) 883-5129
Mailing address
PO BOX 1309 - MAIL STOP 21110Q, MINNEAPOLIS, MS 55440-1309
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12651
MN
Other
Enumeration date
02/22/2018
Last updated
01/11/2023
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