Healthcare Provider Details

I. General information

NPI: 1851955892
Provider Name (Legal Business Name): KEVIN CORRELL KEITH MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 24TH AVE UNIT B
SEATTLE WA
98122-3014
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-2356
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number61331159
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number81422
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61331159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: