Basic Information
| Provider Information | |||||||||
| NPI: | 1578896338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3360 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604866508 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2555 MARVIN RD NE | ||||||||
| Address2: | PMG SW WA OLYMPIA ENDOCRINE | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985163138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604134250 | ||||||||
| FaxNumber: | 3604134256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60454192 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | RN153888 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.