Provider Demographics
NPI:1083847446
Name:KELSO, SHEREE KEARNTA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHEREE
Middle Name:KEARNTA
Last Name:KELSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 NW 25TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1623
Mailing Address - Country:US
Mailing Address - Phone:305-593-2174
Mailing Address - Fax:305-593-1417
Practice Address - Street 1:7800 NW 25TH ST STE 4
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1623
Practice Address - Country:US
Practice Address - Phone:305-593-2174
Practice Address - Fax:305-593-1417
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5153136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse