Healthcare Provider Details

I. General information

NPI: 1356789457
Provider Name (Legal Business Name): KELLY GOMES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY AKIKO CORNETT PSY.D.

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0420
  • Fax:
Mailing address:
  • Phone: 206-341-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60565596
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: