Individual
MIECHELLE KEEL-FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
723 MEMORIAL ST, PROSSER, WA 99350-1524
(509) 786-2222
Mailing address
723 MEMORIAL ST, PROSSER, WA 99350-1524
(509) 786-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025211 PA10003782
WA
363AS0400X
Surgical Physician Assistant
025211 PA10003782
WA
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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