Kelsey Walraven

Primary specialty

PharmacistTaxonomy code 183500000X

License

PST.024428 Issued in LA

Practice address

4890 Barksdale Blvd
Bossier City, LA 71112-4566

Phone

(318) 747-4330

NPI assigned

Aug 11, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelsey Grill Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1225766876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 WALRAVEN RD",
            "city": "DUBBERLY",
            "state": "LA",
            "postal_code": "710242624",
            "telephone_number": "318-560-7560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4890 BARKSDALE BLVD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124566",
            "telephone_number": "318-747-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALRAVEN",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD16248",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "PST.024428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "GRILL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cindy Jean Andrews Wallace, R.D., L.D.N., M.B.A
• Lauren Marie Wallace, PA-C
• Nicholas Preston Wallace, LPC, NCC, CCMHC
• Sadie Noelle Wallace
• Tarkisha Wallace, LPC-S, NCC
• Jessica Walsh
• Arien McKenzie Ward, PSYD
• Richard Wardlaw, NCSP (PENDING)
• Treanna Howard Ware, CSW
• Charity Warner

• Pharmacist in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.