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General NPI Number Information
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NPI Number | 1215856943
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Entity Type | Individual
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Provider Name | KELLY LYNN ELLIS BSN, RN, CDCES
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 615 LILLY RD NE STE 200
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City | OLYMPIA
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State | WA
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Zip | 98506-5137
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Country | US
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Telephone | 360-413-8413
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Fax | 360-413-7143
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Provider Business Mailing Address
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Address Line | 615 LILLY RD NE STE 200
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City | OLYMPIA
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State | WA
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Zip | 98506-5137
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Country | US
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Telephone | 360-413-8413
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Fax | 360-413-7143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 60925221
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License Number State | WA
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