Individual
MICHAEL C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
413 LILLY RD NE, OLYMPIA, WA 98506-5133
(360) 491-9480
Mailing address
PO BOX 5007, LACEY, WA 98509-5007
(800) 599-0166
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30006322
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199382
WA L & I
—
01
—
6059KE
REGENCE BS
—
01
—
8906877
WA CRIME VICTIMS
—
05
—
9635574
—
WA
Enumeration date
06/13/2006
Last updated
07/06/2021
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