Provider Demographics
NPI:1710879150
Name:LEIBENHAUT, KELSEY CARSON (RN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CARSON
Last Name:LEIBENHAUT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 YVONNE MARIE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5715
Mailing Address - Country:US
Mailing Address - Phone:203-253-6142
Mailing Address - Fax:
Practice Address - Street 1:9208 YVONNE MARIE DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5715
Practice Address - Country:US
Practice Address - Phone:203-253-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-77794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse