Provider Demographics
NPI:1710423892
Name:KELLEY, TYANA JEAN (BCE)
Entity Type:Individual
Prefix:
First Name:TYANA
Middle Name:JEAN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 58TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6959
Mailing Address - Country:US
Mailing Address - Phone:509-280-3699
Mailing Address - Fax:
Practice Address - Street 1:12506 58TH AVE SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6959
Practice Address - Country:US
Practice Address - Phone:509-280-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula