Provider Demographics
NPI:1609593565
Name:KELLY, ALESA (RN)
Entity Type:Individual
Prefix:
First Name:ALESA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALESA
Other - Middle Name:
Other - Last Name:SHELLADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15675 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2523
Mailing Address - Country:US
Mailing Address - Phone:206-631-3011
Mailing Address - Fax:
Practice Address - Street 1:4424 S 188TH ST
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5097
Practice Address - Country:US
Practice Address - Phone:206-631-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61340639163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool