Provider Demographics
NPI:1558620013
Name:NOYES, KELLY MAUREEN (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MAUREEN
Last Name:NOYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MAUREEN
Other - Last Name:LISAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 E MANITOBA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3885
Mailing Address - Country:US
Mailing Address - Phone:509-925-6100
Mailing Address - Fax:
Practice Address - Street 1:700 E MANITOBA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-925-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60544143207R00000X
AZ006286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice