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Individual
NICOLE C KELLY
Active
Individual
NICOLE C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00040898
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278149
—
OR
05
—
8316721
—
WA
Enumeration date
06/02/2006
Last updated
09/26/2012
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