Provider Demographics
NPI:1710231857
Name:MAGUIRE, KELLEY MICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:MICHELLE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4029 NORTHWEST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-415-9110
Mailing Address - Fax:360-479-0265
Practice Address - Street 1:9220 RIDGETOP BLVD NW STE 200
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8583
Practice Address - Country:US
Practice Address - Phone:360-415-9110
Practice Address - Fax:360-479-0265
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60316266363LA2200X
WAAP60316266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health