Provider Demographics
NPI:1174363899
Name:HARVEY, KELSEY (HIS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 6TH ST NW STE 7
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2365
Mailing Address - Country:US
Mailing Address - Phone:863-877-0512
Mailing Address - Fax:863-385-5856
Practice Address - Street 1:1495 6TH ST NW STE 7
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2365
Practice Address - Country:US
Practice Address - Phone:863-877-0512
Practice Address - Fax:863-385-5856
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5727237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist