Provider Demographics
NPI:1922456631
Name:KEMMERER, SHELLEY ANNE
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNE
Last Name:KEMMERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MAIN ST STE 435
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6108
Mailing Address - Country:US
Mailing Address - Phone:484-619-0755
Mailing Address - Fax:
Practice Address - Street 1:4311 11TH AVENUE NE, SUITE 200
Practice Address - Street 2:MEDEX NORTHWEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-616-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1147075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant