Individual
MR. KELLY JAMES REMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7345 LINDERSON WAY SW, CEDAR CREEK CORRECTIONS - (RURAL ADDRESS NOT RECOGNIZED, TUMWATER, WA 98501-6504
(360) 359-4070
Mailing address
PO BOX 37, 12200 BORDEAUX ROAD, LITTLEROCK, WA 98556-0037
(360) 359-4070
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 10003612
WA
Other
Enumeration date
06/18/2010
Last updated
12/23/2011
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