Provider Demographics
NPI:1467586883
Name:BELL, KELLY MARTENE (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARTENE
Last Name:BELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1960
Mailing Address - Country:US
Mailing Address - Phone:360-718-2515
Mailing Address - Fax:360-993-1800
Practice Address - Street 1:300 W 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1960
Practice Address - Country:US
Practice Address - Phone:360-718-2515
Practice Address - Fax:360-993-1800
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645201Medicaid
WA8854376Medicare ID - Type Unspecified
WA9645201Medicaid