Healthcare Provider Details

I. General information

NPI: 1396249652
Provider Name (Legal Business Name): KELLEEN MULLANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 101
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-3010
  • Fax: 509-342-3010
Mailing address:
  • Phone: 410-822-1000
  • Fax: 410-770-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME149899
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD95275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: