Organization
NEW LIFE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL KELLY DMSC PAC MHS (PHYSICIAN ASSISTANT, OWNER)
(206) 418-8222
Entity
Organization
Contact information
Practice address
256 E HURLBURT AVE STE 117, HERMISTON, OR 97838-2443
(541) 303-3558
(509) 593-4644
Mailing address
5426 ROAD 68 STE D253, PASCO, WA 99301-5268
(541) 303-3558
(509) 593-4644
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500698482
—
OR
Enumeration date
10/01/2020
Last updated
06/10/2026
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