Provider Demographics
NPI:1669273413
Name:HOWARD, KELLIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9795 MANDUS OLSON RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1575
Mailing Address - Country:US
Mailing Address - Phone:603-860-7886
Mailing Address - Fax:
Practice Address - Street 1:1298 GROW AVE NW
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2708
Practice Address - Country:US
Practice Address - Phone:206-780-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA61649869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant