Provider Demographics
NPI:1780684019
Name:COTE, KELLY L (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:COTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 TORBETT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2604
Mailing Address - Country:US
Mailing Address - Phone:509-946-1695
Mailing Address - Fax:509-946-7666
Practice Address - Street 1:550 GAGE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9532
Practice Address - Country:US
Practice Address - Phone:509-628-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0216407OtherLABOR & INDUSTRIES
WA8486094Medicaid
WAH04601Medicare UPIN
WA0216407OtherLABOR & INDUSTRIES