Basic Information
| Provider Information | |||||||||
| NPI: | 1689041212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRAOKA | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | FNP-BC, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7524 35TH AVE SW APT N106 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108699065 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 8TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067883700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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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 | 363LF0000X | AP 60590729 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.