MEDICARE: TAMMY ROSE KELLY M.D.

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	207V00000X	Obstetrics & Gynecology Physician	9040	NV
2	207V00000X	Obstetrics & Gynecology Physician	MD61508204	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710986997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY ROSE KELLY M.D.

Provider Business Mailing Address
First Line	:	1155 MILL ST # MSM14
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1576
Country	:	US
Telephone Number	:	775-982-5262
Fax Number	:	775-982-3900

Provider Business Practice Location Address
First Line	:	4465 CORDATA PKWY STE 102
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8037
Country	:	US
Telephone Number	:	360-752-5280
Fax Number	:	360-752-5282

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	02/21/2024

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