Basic Information
| Provider Information | |||||||||
| NPI: | 1730766932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOGER | ||||||||
| FirstName: | KELSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6341 CLAIRE DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761311315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179251251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1314 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178100660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2021 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1003010 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.