Provider Demographics
NPI:1679085526
Name:NOBLE-KELLY, KATELIN ANNE (NAC)
Entity Type:Individual
Prefix:MRS
First Name:KATELIN
Middle Name:ANNE
Last Name:NOBLE-KELLY
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 5TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5817
Mailing Address - Country:US
Mailing Address - Phone:774-462-1373
Mailing Address - Fax:
Practice Address - Street 1:200 SW 5TH PL APT A303
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5803
Practice Address - Country:US
Practice Address - Phone:774-462-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide