Individual
MICHAEL KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2811 TIETON DR, YAKIMA, WA 98902-3761
(509) 575-8000
Mailing address
7507 KRISTEN CIR, MABELVALE, AR 72103-8947
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R102525
AR
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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