Individual
KELSY B KELLERMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 431-3769
Mailing address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 431-3769
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2072
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42895200
—
WI
01
—
P00373789
RAILROAD
WI
Enumeration date
10/06/2006
Last updated
05/15/2015
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