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NPI Code Detail

MEDICARE: SHANNON KELLEY

MEDICARE: SHANNON KELLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN00135329WA

General Provider Information

NPI Number : 1215893029
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KELLEY
Provider Business Mailing Address
First Line : 11702 YELM HWY SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9109
Country : US
Telephone Number : 360-459-9603
Fax Number :
Provider Business Practice Location Address
First Line : 11702 YELM HWY SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98513-9109
Country : US
Telephone Number : 360-459-9603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2025
Last Update Date : 12/25/2025

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Directions to “ SHANNON KELLEY ” Practice Location

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