Active NPI
Jennifer Suzanne Kelso
- Pharmacy Technician
- Everett, WA
National Provider Identifier
1750645446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- VA60054959
- Practice address
- 11020 19TH Ave SE
Everett, WA 98208-5155 - Phone
- (425) 337-7197
- Fax
- (425) 337-9287
- NPI assigned
- Jun 27, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | VA60054959 | WA | Primary |
Addresses
Primary practice location
11020 19TH Ave SE
Everett, WA 98208-5155
Mailing address
11020 19TH Ave SE
Everett, WA 98208-5155
Phone (425) 337-7197
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VA60054959 | WA | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340755200000",
"number": "1750645446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11020 19TH AVE SE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982085155",
"telephone_number": "425-337-7197",
"fax_number": "425-337-9287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11020 19TH AVE SE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982085155",
"telephone_number": "425-337-7197",
"fax_number": "425-337-9287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELSO",
"first_name": "JENNIFER",
"middle_name": "SUZANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-27",
"last_updated": "2012-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "WA",
"license": "VA60054959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.