Healthcare Provider Details

I. General information

NPI: 1710986997
Provider Name (Legal Business Name): TAMMY ROSE KELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 DELAWARE ST
LONGVIEW WA
98632-2310
US

IV. Provider business mailing address

1155 MILL ST # MSM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2800
  • Fax: 360-501-3773
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9040
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61508204
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: