Healthcare Provider Details

I. General information

NPI: 1700655594
Provider Name (Legal Business Name): KELSEY MARTELL DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 W 1ST AVE STE 415
SPOKANE WA
99201-3904
US

IV. Provider business mailing address

827 W 1ST AVE STE 415
SPOKANE WA
99201-3904
US

V. Phone/Fax

Practice location:
  • Phone: 509-612-3365
  • Fax:
Mailing address:
  • Phone: 509-612-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELSEY MARTELL
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 509-612-3365