Individual
MR. RANDALL DOUGLAS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHS, DMSC, PA-C
Contact information
Practice address
256 E HURLBURT AVE STE 117, HERMISTON, OR 97838-2443
(541) 303-3558
(509) 593-4644
Mailing address
5426 ROAD 68 STE D253, PASCO, WA 99301-5268
(541) 303-3558
(509) 593-4644
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
184529
OR
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
PA184529
OR
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
PA60205772
WA
363A00000X
Physician Assistant
Primary
PA184529
OR
363A00000X
Physician Assistant
PA60205772
WA
363AM0700X
Medical Physician Assistant
PA184529
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0281857
LABOR & INDUSTRIES
WA
05
—
2013576
—
WA
Enumeration date
06/16/2011
Last updated
03/27/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us