Healthcare Provider Details

I. General information

NPI: 1891864849
Provider Name (Legal Business Name): KELLY ELIZABETH BELTRAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ELIZABETH LEE PA

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE EMERGENCY DEPARTMENT
EVERETT WA
98201-1665
US

IV. Provider business mailing address

1001 N BROADWAY #A11
EVERETT WA
98201-1586
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-2000
  • Fax:
Mailing address:
  • Phone: 425-259-0212
  • Fax: 425-259-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60017286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: