Zachary Kelso

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

25602 W 12 Mile Rd
Southfield, MI 48034-8039

Phone

(313) 221-0260

NPI assigned

Jan 9, 2025

Last updated

Jan 9, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1023828373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25602 W 12 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480348039",
            "telephone_number": "313-221-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25602 W 12 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480348039",
            "telephone_number": "313-221-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSO",
        "first_name": "ZACHARY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-09",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kelly
• Mona Lisa Kelly, LPC
• Sara Kelly
• Steven Kelly
• Demi Kelso
• Kemit PLLC (kemit medical group)
• Meghan Gatward Kemp, DO
• Kathryn Kempczynski
• Mytia Kencaid
• Tiffany Kendall

• Community Health Worker in Southfield, MI
• Providers in Southfield, MI by specialty
• Community Health Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.