Individual
GEORGIE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
209 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4265
(253) 383-6120
Mailing address
1400 POTTERY AVE, PORT ORCHARD MEDICAL CENTER, PORT ORCHARD, WA 98366-3768
(360) 895-5000
(360) 895-5034
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10003604
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8399370
—
WA
Enumeration date
01/16/2007
Last updated
09/14/2017
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