Healthcare Provider Details

I. General information

NPI: 1780684019
Provider Name (Legal Business Name): KELLY L COTE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GAGE BLVD SUITE 2
RICHLAND WA
99352-9532
US

IV. Provider business mailing address

310 TORBETT ST
RICHLAND WA
99354-2604
US

V. Phone/Fax

Practice location:
  • Phone: 509-628-1362
  • Fax:
Mailing address:
  • Phone: 509-946-1695
  • Fax: 509-946-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: