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NPI Code Detail

MEDICARE: REBECCA KATHLEEN SCOPA KELSO PH.D., C.B.S

MEDICARE: REBECCA KATHLEEN SCOPA KELSO PH.D., C.B.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174N00000XLactation Consultant (Non-RN)

General Provider Information

NPI Number : 1588595979
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA KATHLEEN SCOPA KELSO PH.D., C.B.S
Provider Business Mailing Address
First Line : 400 LEE ST N
Second Line :
City : LEWISBURG
State : WV
Zip : 24901-1274
Country : US
Telephone Number : 865-803-1670
Fax Number :
Provider Business Practice Location Address
First Line : 1464 JEFFERSON ST N
Second Line :
City : LEWISBURG
State : WV
Zip : 24901-1380
Country : US
Telephone Number : 865-803-1670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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