MEDICARE: DR. KELLY W BLISS DNP, ARNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30007542	WA
2	363L00000X	Nurse Practitioner	AP30007542	WA

General Provider Information

NPI Number	:	1295812477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY W BLISS DNP, ARNP

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	1600 E OLIVE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/25/2013

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