Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 279584 | NY |
NPI | 1720366347 |
---|---|
Provider Name | Dr. Kelsey Jyl Fawcett |
First Address | Washington, DC 20007-2113 |
Second Address | Washington, DC 20007-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2011 |
Last Update Date | 20/11/2019 |