Provider Demographics
NPI:1144658188
Name:GENOVESSE, KELSEY LARROUY (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LARROUY
Last Name:GENOVESSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LARROUY
Other - Last Name:GENOVESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FINN
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-565-0529
Practice Address - Street 1:907 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3911
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-565-0529
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60538977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant