Organization
NORTHWEST FOOT AND ANKLE SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY J. HALL DPM (OWNER/STAFFING MEMBER/PHYSICIAN)
(206) 365-5484
Entity
Organization
Contact information
Practice address
12900 NE 180TH ST STE 150, BOTHELL, WA 98011-5778
(206) 365-5484
(206) 365-5714
Mailing address
12900 NE 180TH ST, STE 150, BOTHELL, WA 98011
(206) 365-5484
(206) 365-5714
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043268
—
WA
05
—
1106699
—
WA
01
—
1205932191
PROVIDER NPI
WA
01
—
5815682
AETNA
WA
01
—
HA0967
REGENCE
WA
Enumeration date
07/15/2019
Last updated
09/20/2021
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