Provider Demographics
NPI:1003620964
Name:HEWITT, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HEWITT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21121 GIFT RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8955
Mailing Address - Country:US
Mailing Address - Phone:541-280-5973
Mailing Address - Fax:
Practice Address - Street 1:21121 GIFT RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-8955
Practice Address - Country:US
Practice Address - Phone:541-280-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach