Healthcare Provider Details

I. General information

NPI: 1902726995
Provider Name (Legal Business Name): KELLY CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 133RD ST SE APT 521
MILL CREEK WA
98012-5863
US

IV. Provider business mailing address

4015 133RD ST SE APT 521
MILL CREEK WA
98012-5863
US

V. Phone/Fax

Practice location:
  • Phone: 253-444-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: