Healthcare Provider Details

I. General information

NPI: 1346585163
Provider Name (Legal Business Name): KELLY ELIZABETH BAKER ND, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 ROOSEVELT WAY NE STE 100
SEATTLE WA
98125-6243
US

IV. Provider business mailing address

11300 ROOSEVELT WAY NE STE 100
SEATTLE WA
98125-6243
US

V. Phone/Fax

Practice location:
  • Phone: 206-264-1111
  • Fax: 206-749-4100
Mailing address:
  • Phone: 206-264-1111
  • Fax: 206-749-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 60285882
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60319049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: