Provider Demographics
NPI:1699855544
Name:WELZ, KELLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:WELZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5456
Mailing Address - Fax:425-303-3091
Practice Address - Street 1:3901 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-339-5456
Practice Address - Fax:425-303-3091
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006275363LF0000X, 363L00000X
OR201050150NP363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC MAIN GROUP NPI
OR201050150NPOtherOREGON LICENSE - NURSE PRACTITIONER WTH PRESCRIPTIVE PRIVLEGES-FAMILY
ORR0000WFBTVOtherNBMC GROUP MEDICARE
OR161133OtherNBMC MAIN GROUP DMAP
OR500625806Medicaid
OR930635514OtherNBMC GROUP TAX ID
OR930635514OtherNBMC GROUP TAX ID
OR500625806Medicaid