Provider Demographics
NPI:1063075646
Name:HABERMEHL, KELSEY ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:HABERMEHL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:605 GROVER CLEVELAND HWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2997
Mailing Address - Country:US
Mailing Address - Phone:716-836-3300
Mailing Address - Fax:
Practice Address - Street 1:605 GROVER CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-2997
Practice Address - Country:US
Practice Address - Phone:716-836-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343973363LF0000X
NY720365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse