Healthcare Provider Details

I. General information

NPI: 1790639680
Provider Name (Legal Business Name): CHERISSE KELSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST
WESTON MA
02493-1572
US

IV. Provider business mailing address

18553 8TH AVE NE APT 436
SHORELINE WA
98155-2272
US

V. Phone/Fax

Practice location:
  • Phone: 808-375-3538
  • Fax:
Mailing address:
  • Phone: 808-375-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN60725011
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: