Healthcare Provider Details

I. General information

NPI: 1629782511
Provider Name (Legal Business Name): KELLEN BYRNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E 5TH AVE
SPOKANE WA
99202-1309
US

IV. Provider business mailing address

500 SW 7TH ST STE A205
RENTON WA
98057-2983
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone: 509-222-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61386726
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP61386726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: