Healthcare Provider Details

I. General information

NPI: 1285908780
Provider Name (Legal Business Name): K&S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 39TH ST
VANCOUVER WA
98660-1960
US

IV. Provider business mailing address

300 W 39TH ST
VANCOUVER WA
98660-1960
US

V. Phone/Fax

Practice location:
  • Phone: 360-718-2515
  • Fax: 360-993-1800
Mailing address:
  • Phone: 360-718-2515
  • Fax: 360-993-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005937
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30006359
License Number StateWA

VIII. Authorized Official

Name: KELLY MARTENE BELL
Title or Position: PARTNER
Credential: NP
Phone: 360-718-2515