Healthcare Provider Details

I. General information

NPI: 1295969756
Provider Name (Legal Business Name): JENNIFER COBELLI KETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ELIZABETH COBELLI

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S L ST
TACOMA WA
98405-3720
US

IV. Provider business mailing address

311 S L ST
TACOMA WA
98405-3720
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1420
  • Fax:
Mailing address:
  • Phone: 253-403-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberMD 60285199
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: