Provider Demographics
NPI:1689397218
Name:DEARMON, KELSEY DIANE (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DIANE
Last Name:DEARMON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:DIANE
Other - Last Name:ROUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CONTEMPO AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5382
Mailing Address - Country:US
Mailing Address - Phone:318-324-0111
Mailing Address - Fax:318-324-9679
Practice Address - Street 1:107 CONTEMPO AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5382
Practice Address - Country:US
Practice Address - Phone:318-324-0111
Practice Address - Fax:318-324-9679
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227189363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics