Provider Demographics
NPI:1235119587
Name:FAUCETTE, KELLY J (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:FAUCETTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18111 89TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6238
Mailing Address - Country:US
Mailing Address - Phone:253-847-6366
Mailing Address - Fax:253-968-1900
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2206
Practice Address - Fax:253-968-1900
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-05-09
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Provider Licenses
StateLicense IDTaxonomies
UT181132-12052080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD-000Medicare UPIN