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General NPI Number Information
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NPI Number | 1942458260
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Entity Type | Individual
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Provider Name | SARAH E KELSO APN/CPNP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 733 ALQER ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3530
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Country | US
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Telephone | 616-243-9515
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Fax | 616-243-1815
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Provider Business Mailing Address
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Address Line | 733 ALQER ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3530
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Country | US
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Telephone | 616-243-9515
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Fax | 616-243-1815
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 041338008
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209007232
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License Number State | IL
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