Healthcare Provider Details

I. General information

NPI: 1295812477
Provider Name (Legal Business Name): KELLY W BLISS DNP, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

IV. Provider business mailing address

1600 E OLIVE ST
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2200
  • Fax: 206-302-2210
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007542
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30007542
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: