Provider Demographics
NPI:1659646115
Name:PAULSON, KELLY GARNESKI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GARNESKI
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARY
Other - Last Name:GARNESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 5TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3186
Mailing Address - Country:US
Mailing Address - Phone:425-775-1677
Mailing Address - Fax:425-778-1635
Practice Address - Street 1:21632 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-775-1677
Practice Address - Fax:425-778-1635
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60494102207RX0202X
WAML60285304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology