Individual
DR. KELLY RYAN GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 HIGHLINE DR, EAST WENATCHEE, WA 98802-5341
(509) 884-0614
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00045213
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220234
L&I
WA
05
—
1427109974
—
WA
01
—
314726
L&I POST 7/21/13
WA
01
—
P01256547
RR MEDICARE
WA
Enumeration date
01/12/2007
Last updated
06/21/2022
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