Individual
STEPHEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-5086
(609) 774-4071
Mailing address
9315 WINDSOR LN NE # A202, OLYMPIA, WA 98516-5953
(609) 774-4071
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
61188032
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/16/2019
Last updated
11/13/2024
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