MEDICARE: KELSEY WILDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1770441966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY WILDER

Provider Business Mailing Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:	360-895-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	04/26/2026

Similar Medicare Providers

1285605451 — BRIAN ALAN SMOLEY MD, MPH, FAAFP
Practice Location Address:

450 S KITSAP BLVD STE 210
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-874-5900
Practice Fax: 360-874-5959

1215900303 — DR. MARK IAN ANDERSON M.D.
Practice Location Address:

450 S KITSAP BLVD STE 210
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-895-8950
Practice Fax: 360-895-8980

1679505515 — DR. SAMAY JAIN M.D.
Practice Location Address:

450 S KITSAP BLVD STE 210
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-895-8950
Practice Fax: 360-830-1385

1619901212 — MRS. LESLIE BROWN ARNP
Practice Location Address:

450 S KITSAP BLVD STE 230
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-895-0216
Practice Fax: 360-895-7919

1366476509 — CATHERINE COGLEY MD
Practice Location Address:

450 S KITSAP BLVD STE 230
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-895-0216
Practice Fax: 360-895-7919

1982854006 — DR. JADE-LIN MORTON DMD
Practice Location Address:

450 S KITSAP BLVD STE 220
PORT ORCHARD, WA
98366-3738

Practice Phone: 360-447-5100
Practice Fax:

Directions to “ KELSEY WILDER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.