Provider Demographics
NPI:1619624285
Name:NERING, KELLY JOY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JOY
Last Name:NERING
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 1:24061 SE 264TH ST UNIT M200
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3367
Mailing Address - Country:US
Mailing Address - Phone:425-278-6485
Mailing Address - Fax:
Practice Address - Street 1:24061 SE 264TH ST UNIT M200
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3367
Practice Address - Country:US
Practice Address - Phone:425-278-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60556788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist