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General NPI Number Information
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NPI Number | 1336580109
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Entity Type | Individual
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Provider Name | KELLY MARTIN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 6642 S 193RD PL STE N106
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City | KENT
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State | WA
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Zip | 98032-3109
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Country | US
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Telephone | 206-486-4867
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22881
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City | SEATTLE
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State | WA
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Zip | 98122-0881
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Country | US
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Telephone | 206-486-4867
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Fax | 206-743-0948
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 5616
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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