Kelly, Michael C

Kelly, Michael C is an individual health care provider with primary practice located at 413 Lilly Rd Ne , Olympia WA 98506-5133. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Kelly, Michael C can be contacted via phone (360) 491-9480.

Contact Information

Primary practice address
413 Lilly Rd Ne Olympia WA 98506-5133
Phone: (360) 491-9480
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP30006322 Washington

Profile Details

NPI number 1760425201
LBN Legal business name Kelly, Michael C
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jul 6th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760425201 NPPES
Other 8906877 WA CRIME VICTIMS
Other 6059KE WA CRIME VICTIMS
Other 199382 WA CRIME VICTIMS
MEDICAID 9635574 WA CRIME VICTIMS

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