Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60686686 | WA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60686686 | WA |
NPI | 1366806267 |
---|---|
Provider Name | Kelsey Keaton Solano |
First Address | Richland, WA 99352-8650 |
Second Address | Richland, WA 99352-3514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366806267 | (05) | WA |