Individual
DR. KELLY BLAKE EBRAHIMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-5001
(253) 968-2252
Mailing address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
DOS-2292
HI
2084P0800X
Psychiatry Physician
Primary
OP61575651
WA
208D00000X
General Practice Physician
DOS-2292
HI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2020
Last updated
08/14/2024
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