Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00023018 | WA |
N | 207NP0225X | Pediatric Dermatologist | MD00023018 | WA |
N | 207NS0135X | Procedural Dermatology | MD00023018 | WA |
NPI | 1205930351 |
---|---|
Provider Name | Sharon B Kelly |
First Address | Bellevue, WA 98007 |
Second Address | Bellevue, WA 98007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1068816 | (05) | WA |
4291026 | AETNA (01) | WA |
7080237 | (05) | WA |
CN9262 | RAILROAD MEDICARE GROUP (01) | WA |
E72564 | (02) | |
KE2842 | REGENCE (01) | WA |