Provider Demographics
NPI:1669976387
Name:MARTELL, KELSEY LOUISE (DO)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LOUISE
Last Name:MARTELL
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 1:827 W 1ST AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3904
Mailing Address - Country:US
Mailing Address - Phone:509-612-3365
Mailing Address - Fax:
Practice Address - Street 1:827 W 1ST AVE STE 415
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3904
Practice Address - Country:US
Practice Address - Phone:509-612-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAOP612544322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program