KELSEY GENE BROOME (NPI# 1013253228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1013253228 |
Entity Type | Individual |
Full Name | KELSEY GENE BROOME |
Credential | PHYSICIAN ASSISTANT |
Practice Address |
10 Missile Ave Minot Afb ND 58705-5003 |
Mailing Address |
401 Northampton Circle Fort Walton Beach FL 32547 |
Practice Telephone | 7017235232 |
Mailing Telephone | 4054105622 |
Enumeration Date | 2012-12-14 |
Last Update Date | 2019-12-26 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care | ||
N | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
Street Address |
10 MISSILE AVE |
City | MINOT AFB |
State | ND |
Zip Code | 58705-5003 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427031673 | 5th Medical Group | Military/U.S. Coast Guard Pharmacy | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2005-11-22 |
1952936825 | Dylan M Morales | Military Health Care Provider | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2020-03-11 |
1598127862 | Thomas Wagoner | Pediatrics | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2016-03-24 |
1093142275 | Aaron D Geyer | Physician Assistant | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2013-10-02 |
1649605072 | Jared Jon Solomon | Psychiatry & Neurology | 10 Missile Ave, Minot Afb, ND 58705 | 2013-09-04 |
1023457256 | Matthew Wayne Greene | Family Medicine | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2013-06-20 |
1033491121 | Patrick Mccue | Physician Assistant | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2011-09-14 |
1760764393 | 5th Medical Group | Military Hospital | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2011-09-09 |
1366754400 | Dfas-jfll/in | Military Hospital | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2010-07-06 |
1508097247 | Agnes Liem | Registered Nurse | 10 Missile Ave, Minot Afb, ND 58705-5003 | 2009-07-29 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265093900 | Coty Winn | Student in an Organized Health Care Education/Training Program | Minot Afb Medical Group, 194 Missile Avenue, Minot Afb, ND 58705 | 2019-06-24 |
1144717596 | Angela Kennedy | Social Worker | 5 Mdg 194 Missile Avenue, Minot Afb, ND 58705 | 2018-04-20 |
1386064780 | Desiree Avedon Aaron-barber | Licensed Practical Nurse | Minot Va Cboc, Minot Air Force Base, Minot, ND 58705 | 2014-04-24 |
1366771644 | Melanie Renee Roserie | Social Worker | 194 Missile Avenue, Minot Afb - 5 Mdg Mental Health Clinic, Minot, ND 58705 | 2009-12-15 |
1255565289 | Javier Alberto Padial | Pediatrics | 194 Missle Ave., Minot Afb, Apo, AA 58705 | 2009-05-05 |
1184694127 | Michelle Joy Fundingsland | Dietitian, Registered | 201 Missile Ave, Minot Afb, ND 58705 | 2006-01-24 |
1306404645 | Yongke Tan | Pharmacist | 194 Missile Avenue, Minot Afb, ND 58705 | 2019-06-02 |
1689106320 | Priscilla Barrio | Student in an Organized Health Care Education/Training Program | 194 Missile Ave, Minot Afb, ND 58705 | 2017-03-31 |
1881953602 | Casey Simon Brock | Physician Assistant | 194 Missile Avenue, Minot Air Force Base, ND 58705 | 2012-05-14 |
1154618973 | Brian Grant Kay | Social Worker | 194 Missile Ave, Minot, ND 58705 | 2011-06-30 |
Find all providers in zip 58705 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730162330 | Anne Patricia Heinly | Physician Assistant | 10 Missle Ave, Minot Afb, ND 58705-5003 | 2005-11-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891355608 | Jenny L Brown | Physician Assistant | 3750 19th St Sw, Center, ND 58530-9700 | 2019-06-14 |
1407335383 | Chelsey Galipeau | Physician Assistant | 516 1st Ave Sw, Dickinson, ND 58601-5906 | 2018-08-10 |
1093184657 | Grant Lannoye | Physician Assistant | 7448 Us Hwy 281, Cando, ND 58324-0688 | 2015-09-24 |
1821408907 | Laramie Jay Richmond | Physician Assistant | 311 Davis St N, Burlington, ND 58722-2027 | 2014-04-29 |
1962749226 | Lindsey K Baker | Physician Assistant | 1600 2nd Ave Sw Ste 19, Minot, ND 58701-3459 | 2013-01-07 |
1205015633 | Jamie M Brown | Physician Assistant | 1711 Gold Dr S, Suite 170, Fargo, ND 58103-6416 | 2007-11-02 |
1811036247 | Tyesha Dawn Marie Dent | Physician Assistant | 302 North Main, Elgin, ND 58533 | 2007-02-05 |
1629160080 | Teresa Nielsen | Physician Assistant | 820 2nd Ave W, New England, ND 58647 | 2006-09-29 |
1841208394 | Lynette Marie Azure | Physician Assistant | 320 4th St Se, Devils Lake, ND 58301-3610 | 2006-08-03 |
1790703353 | Mary Jane Kadry | Physician Assistant | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2006-07-18 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.