Active NPI
Paula Mae Kelsor, R
- Radiologic Technologist
- Fernandina Beach, FL
National Provider Identifier
1902824766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- 63980
- Practice address
- 1699 S 14TH St
Ste 16
Fernandina Beach, FL 32034-1963 - Phone
- (904) 491-7700
- Fax
- (904) 491-7701
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 63980 | FL | Primary |
Addresses
Primary practice location
1699 S 14TH St
Ste 16
Fernandina Beach, FL 32034-1963
Mailing address
1548 Golf Forest Dr
Jacksonville, FL 32208-6626
Phone (904) 766-8956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63980 | FL | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902824766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1548 GOLF FOREST DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322086626",
"telephone_number": "904-766-8956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1699 S 14TH ST",
"address_2": "STE 16",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320341963",
"telephone_number": "904-491-7700",
"fax_number": "904-491-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELSOR",
"first_name": "PAULA",
"middle_name": "MAE",
"credential": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "FL",
"license": "63980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fernandina Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.