Basic Information
| Provider Information | |||||||||
| NPI: | 1932394772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 W PINE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991569046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094472441 | ||||||||
| FaxNumber: | 5094470456 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 W PINE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991569046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094472441 | ||||||||
| FaxNumber: | 5094470456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA10005237 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.