Provider Demographics
NPI:1134505753
Name:HOWELL, KELLY MORGAN (LMP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MORGAN
Last Name:HOWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 S HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4147
Mailing Address - Country:US
Mailing Address - Phone:360-305-1068
Mailing Address - Fax:
Practice Address - Street 1:1487 NE DAWN RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3122
Practice Address - Country:US
Practice Address - Phone:360-373-8899
Practice Address - Fax:360-373-8891
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60133164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist