Provider Demographics
NPI:1578896338
Name:KELLEY, JULIA ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E MAIN STE 104
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3814
Mailing Address - Country:US
Mailing Address - Phone:534-466-9772
Mailing Address - Fax:253-604-4703
Practice Address - Street 1:1029 E MAIN STE 104
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3814
Practice Address - Country:US
Practice Address - Phone:253-446-6977
Practice Address - Fax:253-604-4703
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60454192363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner