Individual
KELLIE LEECLAIRE DUARTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, PA-C
Contact information
Practice address
8656 W GAGE BLVD STE 301B, KENNEWICK, WA 99336-7145
(509) 222-1275
Mailing address
8514 W GAGE BLVD, SUITE G, KENNEWICK, WA 99336-8108
(509) 222-1275
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
RC00054737
WA
363A00000X
Physician Assistant
Primary
PA60610771
WA
390200000X
Student in an Organized Health Care Education/Training Program
1306034277
WA
Other
Enumeration date
10/04/2007
Last updated
12/06/2017
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