Healthcare Provider Details

I. General information

NPI: 1629981907
Provider Name (Legal Business Name): LESLIE RAE KELLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

12725 140TH AVE NW
GIG HARBOR WA
98329-4665
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-0000
  • Fax:
Mailing address:
  • Phone: 253-315-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License NumberARNP.AP.70173632-CNS
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: