MEDICARE: MS. KELLY CARPER LMP

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	174400000X	Specialist	533108-07	WA

General Provider Information

NPI Number	:	1679758320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY CARPER LMP

Provider Business Mailing Address
First Line	:	7527 22ND AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4312
Country	:	US
Telephone Number	:	206-545-1884
Fax Number	:

Provider Business Practice Location Address
First Line	:	7527 22ND AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4312
Country	:	US
Telephone Number	:	206-545-1884
Fax Number	:

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

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	12/31/2007

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