Kelly Ellen Kafka, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

2007011381 Issued in MO

Practice address

9040 Jackson Ave
Tacoma, WA 98431-0001

Phone

(253) 968-2252

NPI assigned

May 12, 2007

Last updated

Jun 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kelly Ellen Lesperance Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1178928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1275748220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-2252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-2252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Brooke Army Medical Center",
            "address_2": "3551 Roger Brooke Drive",
            "address_purpose": "LOCATION",
            "city": "Ft. Sam Houston",
            "state": "TX",
            "postal_code": "78234",
            "country_code": "US",
            "telephone_number": "210-916-3216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAFKA",
        "first_name": "KELLY",
        "middle_name": "ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-12",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "75893",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2007011381",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MO",
            "license": "2007011381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "MAMC",
            "affiliation": "N",
            "address_1": "9040 Jackson Ave",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984310001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LESPERANCE",
            "middle_name": "ELLEN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carey Yuri Kadohiro
• Faith Kadoshima
• Mark F Kadoshima, DDS
• Jacquelin Kae, MD
• Susan Miye Kaeka, P.T.
• Navyamani Venkata Durga Kagita, MD
• Robert A. Kahle, M.D.
• Audry Jean Kahlstrom, ARNP
• Richard A Kahlstrom, MD
• Robert Anthony Kahns, PHARM.D.

• Plastic and Reconstructive Surgery Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Plastic and Reconstructive Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.