Healthcare Provider Details

I. General information

NPI: 1568739357
Provider Name (Legal Business Name): KELLY JEAN PAANANEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE # MS 359797
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE # MS 359797
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9600
  • Fax: 206-744-9919
Mailing address:
  • Phone: 206-744-9600
  • Fax: 206-744-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60188586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: