Individual
KEVIN RYAN KELLOGG
Active
Individual
KEVIN RYAN KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10005240
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223708
LABOR & INDUSTRIES
WA
05
—
8489171
—
WA
01
—
8869632
MEDICARE
—
Enumeration date
11/21/2005
Last updated
03/01/2021
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