Healthcare Provider Details

I. General information

NPI: 1407244395
Provider Name (Legal Business Name): JAMIE LYNN KELLEY F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN WENDLING F.N.P.

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E CENTRAL AVE STE 360
SPOKANE WA
99208-4502
US

IV. Provider business mailing address

212 E CENTRAL AVE STE 360
SPOKANE WA
99208-4502
US

V. Phone/Fax

Practice location:
  • Phone: 509-553-0565
  • Fax:
Mailing address:
  • Phone: 509-553-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR879610
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61158154
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879610
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61158161
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: