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General NPI Number Information
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NPI Number | 1043690910
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Entity Type | Individual
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Provider Name | KELSEY LOUAINE CHEREPUSCHAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 805 SE CLEARWATER DR
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City | PULLMAN
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State | WA
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Zip | 99163-7007
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Country | US
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Telephone | 208-892-1346
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SE CLEARWATER DR
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City | PULLMAN
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State | WA
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Zip | 99163-7007
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Country | US
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Telephone | 208-892-1346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61686351
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 9871652
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9871652
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A147541
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD61686351
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License Number State | WA
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