Individual
KELSEY H SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3881
WI
363AS0400X
Surgical Physician Assistant
Primary
085008913
IL
363AS0400X
Surgical Physician Assistant
3881-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060159
—
WI
Enumeration date
08/08/2016
Last updated
05/23/2022
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