Provider Demographics
NPI:1831345610
Name:JONES, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JONES
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 1:210 SE PIONEER WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5704
Mailing Address - Country:US
Mailing Address - Phone:360-679-8600
Mailing Address - Fax:360-679-8554
Practice Address - Street 1:210 SE PIONEER WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5704
Practice Address - Country:US
Practice Address - Phone:360-679-8600
Practice Address - Fax:360-679-8554
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMA00025337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist