Provider Demographics
NPI:1851770416
Name:FREESE, KELLY (DVM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FREESE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:SEAVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98644-0449
Mailing Address - Country:US
Mailing Address - Phone:360-642-2232
Mailing Address - Fax:
Practice Address - Street 1:3717 PACIFIC WAY
Practice Address - Street 2:
Practice Address - City:SEAVIEW
Practice Address - State:WA
Practice Address - Zip Code:98644
Practice Address - Country:US
Practice Address - Phone:360-642-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT60479427174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian