Individual
JENNIFER LYNN KELSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1918 RANDOLPH RD, SUITE 175, CHARLOTTE, NC 28207-1100
(704) 316-1050
(704) 316-1051
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-1050
(704) 316-1051
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301074437
MI
207P00000X
Emergency Medicine Physician
Primary
9800297
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104144930
—
MI
01
—
930084992
RR MEDICARE
MI
Enumeration date
06/06/2006
Last updated
10/27/2008
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