Provider Demographics
NPI:1043690910
Name:CHEREPUSCHAK, KELSEY LOUAINE (MD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:LOUAINE
Last Name:CHEREPUSCHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SE CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-7007
Mailing Address - Country:US
Mailing Address - Phone:208-892-1346
Mailing Address - Fax:
Practice Address - Street 1:805 SE CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-7007
Practice Address - Country:US
Practice Address - Phone:208-892-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61686351207Q00000X, 2083P0901X
ID98716522083P0901X, 207Q00000X
CAA147541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine