Provider Demographics
NPI:1306211776
Name:DR. KELLYN MISSET PLLC
Entity Type:Organization
Organization Name:DR. KELLYN MISSET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSET
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-547-5959
Mailing Address - Street 1:753 N 35TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8870
Mailing Address - Country:US
Mailing Address - Phone:206-547-5959
Mailing Address - Fax:877-417-9426
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-547-5959
Practice Address - Fax:877-417-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60316747261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center