Provider Demographics
NPI:1700221611
Name:DEMEYERE-COURSEY, KELLY C (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:DEMEYERE-COURSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:TACOMA FAMILY MEDICINE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4238
Mailing Address - Country:US
Mailing Address - Phone:253-792-6680
Mailing Address - Fax:253-403-2915
Practice Address - Street 1:521 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:TACOMA FAMILY MEDICINE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4238
Practice Address - Country:US
Practice Address - Phone:253-792-6680
Practice Address - Fax:253-403-2915
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program