Provider Demographics
NPI:1477919207
Name:KELLEY, TRACY
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:KELLEY
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 1:115 124TH ST SE APT M5
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5752
Mailing Address - Country:US
Mailing Address - Phone:425-268-5515
Mailing Address - Fax:
Practice Address - Street 1:115 124TH ST SE APT M5
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5752
Practice Address - Country:US
Practice Address - Phone:425-268-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other