Provider Demographics
NPI:1780322610
Name:CONFER, KELLEY (RN)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CONFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:SHINABARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19736 40TH CT NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1604
Mailing Address - Country:US
Mailing Address - Phone:206-715-1677
Mailing Address - Fax:
Practice Address - Street 1:19736 40TH CT NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-1604
Practice Address - Country:US
Practice Address - Phone:206-715-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00155255163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator