Healthcare Provider Details

I. General information

NPI: 1649493438
Provider Name (Legal Business Name): JESSICA ALAINE KEHOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

IV. Provider business mailing address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-6100
  • Fax:
Mailing address:
  • Phone: 425-882-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML20008244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: