Healthcare Provider Details

I. General information

NPI: 1043473796
Provider Name (Legal Business Name): LISABETH CARLISLE KELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISABETH CARLISLE M.D.

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 N MAPLE ST
SPOKANE WA
99205-1349
US

IV. Provider business mailing address

611 N IRON BRIDGE WAY
SPOKANE WA
99202-4932
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone: 509-444-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61467593
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA110776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: