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General NPI Number Information
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NPI Number | 1770441966
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Entity Type | Individual
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Provider Name | KELSEY WILDER
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Gender |
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 450 S KITSAP BLVD STE 210
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City | PORT ORCHARD
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State | WA
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Zip | 98366-3738
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Country | US
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Telephone | 360-895-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 14025 S KEYPORT RD NE
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City | POULSBO
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State | WA
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Zip | 98370-7942
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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