Active NPI
Teresa M Kelly, A.R.N.P.
- Obstetrics & Gynecology Nurse Practitioner
- Spokane, WA
National Provider Identifier
1104835578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Nurse Practitioner
- License
- AP30000509
- Practice address
- 105 W 8TH Ave Ste 6020
Spokane, WA 99204-2319 - Phone
- (509) 455-5050
- Fax
- (509) 789-6204
- NPI assigned
- Aug 5, 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | AP30000509 | WA | Primary |
Addresses
Primary practice location
105 W 8TH Ave Ste 6020
Spokane, WA 99204-2319
Mailing address
105 W 8TH Ave Ste 6020
Spokane, WA 99204-2319
Phone (509) 455-5050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9616301 | Medicaid | WA |
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 |
|---|---|---|---|
| AP30000509 | WA | MD | Obstetrics & Gynecology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104835578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W 8TH AVE STE 6020",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042319",
"telephone_number": "509-455-5050",
"fax_number": "509-789-6204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W 8TH AVE STE 6020",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992042319",
"telephone_number": "509-455-5050",
"fax_number": "509-789-6204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TERESA",
"middle_name": "M",
"credential": "A.R.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "WA",
"license": "AP30000509",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9616301",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.