Provider Demographics
NPI:1164205043
Name:KELSO, KRISTEN E
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:KELSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1529
Mailing Address - Country:US
Mailing Address - Phone:850-463-4999
Mailing Address - Fax:850-361-3443
Practice Address - Street 1:5345 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1529
Practice Address - Country:US
Practice Address - Phone:850-463-4999
Practice Address - Fax:850-361-3443
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician