William Samuel Kelly, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

33548 Issued in WA

Practice address

9600 Veterans Dr SW
Tacoma, WA 98493-0003

Phone

(253) 583-1698

Fax

(253) 589-4167

NPI assigned

Aug 17, 2006

Last updated

Mar 10, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Behavioral Health Resources

  • Community/Behavioral Health Agency
  • Olympia, WA
  • NPI 1093895203
  NPD
• Behavioral Health Resources

  • Community/Behavioral Health Agency
  • Hoquiam, WA
  • NPI 1992989297
  NPD
• Navos

  • Psychiatric Hospital
  • Seattle, WA
  • NPI 1124034699
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1073626453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 VETERANS DR SW",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984930003",
            "telephone_number": "253-583-1698",
            "fax_number": "253-589-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 VETERANS DR SW",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984930003",
            "telephone_number": "253-583-1698",
            "fax_number": "253-589-4167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4445 Talbot Rd S",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980556219",
            "country_code": "US",
            "telephone_number": "425-690-3414",
            "fax_number": "425-690-9414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "WILLIAM",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "33548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE W VALLEY MEDICAL GROUP - RENTON",
            "identifier": "G8891457",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2009646",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Kelly, DO
• Sean Kelly, D.D.S.
• Stephen Kelly, PA-C
• Tawny Kelly
• Tracy T Kelly, MD
• Kemet Beauty, LLC
• Eileen Padden Kemink, LMP
• Taylor Kemp
• Paul M Kempff, MA
• Aryanna Maluai Kendall

• Psychiatry Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.