Individual
TIMOTHY A. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 S AUBURN ST, KENNEWICK, WA 99336-5621
(509) 586-5840
Mailing address
PO BOX 34940, SEATTLE, WA 98124-1940
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00100988
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30003834
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262830
—
OR
05
—
9616996
—
WA
Enumeration date
06/15/2006
Last updated
11/20/2007
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