Individual
MRS. KELLY RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1011 E MAIN AVE STE 201, PUYALLUP, WA 98372-6777
(253) 845-2013
(253) 845-2030
Mailing address
1011 E MAIN AVE STE 201, PUYALLUP, WA 98372-6777
(253) 845-2013
(253) 845-2030
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00015467
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00015467
STATE LICENSE
WA
Enumeration date
10/29/2009
Last updated
10/29/2009
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