Active NPI
Diane M Kelly, LMP
- Specialist
- Vancouver, WA
National Provider Identifier
1083672406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA0005268
- Practice address
- 7902 NE St Johns Rd
Vancouver, WA 98665-1094 - Phone
- (360) 573-6424
- NPI assigned
- May 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA0005268 | WA | Primary |
Addresses
Primary practice location
7902 NE St Johns Rd
Vancouver, WA 98665-1094
Mailing address
9105 NE 25TH Ave
Vancouver, WA 98665-9057
Phone (360) 573-8183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA0005268 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1083672406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9105 NE 25TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986659057",
"telephone_number": "360-573-8183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7902 NE ST JOHNS RD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986651094",
"telephone_number": "360-573-6424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "DIANE",
"middle_name": "M",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA0005268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.