Provider Demographics
NPI:1710306535
Name:MCCAFFREY, KELLY ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:916 N 10TH PL BLDG 306 SPC B
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5540
Practice Address - Country:US
Practice Address - Phone:425-391-5770
Practice Address - Fax:425-391-5771
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61173363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710306535Medicaid