Individual
MRS. HOLLY JO KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA CNOR
Contact information
Practice address
520 N 4TH AVE, PASCO, WA 99301-5257
(509) 546-2203
(509) 546-2262
Mailing address
3333 N WHITMAN ST, TACOMA, WA 98407-1547
(253) 759-3065
(253) 759-3075
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
025801 RN00114875
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9632084
—
WA
Enumeration date
11/01/2006
Last updated
07/08/2007
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