Provider Demographics
NPI:1114541836
Name:SCOTT, KESSLEY BLEU MEDINA (DO)
Entity Type:Individual
Prefix:
First Name:KESSLEY
Middle Name:BLEU MEDINA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9927 MICKELBERRY RD NW STE 131
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7861
Mailing Address - Country:US
Mailing Address - Phone:360-337-5800
Mailing Address - Fax:360-692-1392
Practice Address - Street 1:9927 MICKELBERRY RD NW STE 131
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7861
Practice Address - Country:US
Practice Address - Phone:360-337-5800
Practice Address - Fax:360-692-1392
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61326828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine