Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A0001260 | MD |
Y | 213ES0000X | Sports Medicine | A0001260 | MD |
NPI | 1295331957 |
---|---|
Provider Name | Ms. Kelsey Mcculley |
First Address | Frederick, MD 21703-7953 |
Second Address | Frederick, MD 21701-4430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 08/12/2020 |