Kelsey B Glover, PA-C
Individual provider Active NPI Medical Physician Assistant · Portland, TN
NPI 1265026041 · NPPES record last updated Mar 6, 2021
Key facts
- NPI
- 1265026041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- Practice address
- 124 Ewing Dr
Portland, TN 37148-1681 - Phone
- (615) 714-6065
- NPI assigned
- Feb 23, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230403002169 | OH | Practitioner - Physician Assistant | 9931509015 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Yes |
Addresses
Primary practice location
124 Ewing Dr
Portland, TN 37148-1681
Mailing address
124 Ewing Dr
Portland, TN 37148-1681
Phone (615) 714-6065
Other providers in Portland, TN
- Firefly Health PLLC
- First Class Therapy
- Sherry T Flecksteiner
- Lisa Lynn Frady
- Marcos Franco
- Shelby Harpel
- Elizabeth Harrington
- Jennifer Lynn Harris
- Clark Hastings
- Hendersonville Hospital Corporation
All providers in Portland, TN · Medical Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.