Healthcare Provider Details

I. General information

NPI: 1659087096
Provider Name (Legal Business Name): KERRY ALECCIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ALTA ST SW APT D303
OLYMPIA WA
98502-6105
US

IV. Provider business mailing address

800 ALTA ST SW APT D303
OLYMPIA WA
98502-6105
US

V. Phone/Fax

Practice location:
  • Phone: 307-441-0661
  • Fax:
Mailing address:
  • Phone: 307-441-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN61156952
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61156952
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: