Healthcare Provider Details

I. General information

NPI: 1710231857
Provider Name (Legal Business Name): KELLEY MICHELLE MAGUIRE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 RIDGETOP BLVD NW STE 200
SILVERDALE WA
98383-8583
US

IV. Provider business mailing address

4029 NORTHWEST AVE STE 301
BELLINGHAM WA
98226-9077
US

V. Phone/Fax

Practice location:
  • Phone: 360-415-9110
  • Fax: 360-479-0265
Mailing address:
  • Phone: 360-415-9110
  • Fax: 360-479-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP 60316266
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60316266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: