Individual
TRENT KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
511 MELINE RD SE, PORT ORCHARD, WA 98367-7551
(360) 440-8699
Mailing address
511 MELINE RD SE, PORT ORCHARD, WA 98367-7551
(360) 440-8699
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60429754
WA
Other
Enumeration date
12/11/2013
Last updated
08/11/2015
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