Provider Demographics
NPI:1437917382
Name:WASHINGTON, KELLI JOY
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JOY
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6733 KISSENA BLVD APT 1A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1556
Mailing Address - Country:US
Mailing Address - Phone:347-854-3430
Mailing Address - Fax:347-317-5671
Practice Address - Street 1:14307A LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5407
Practice Address - Country:US
Practice Address - Phone:347-854-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide