John Kelly

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

CG60419820 Issued in WA

Practice address

1118 Poindexter Ave W
Bremerton, WA 98312-4337

Phone

(360) 204-1723

NPI assigned

Feb 23, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1456185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1588023246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 POINDEXTER AVE W",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983124337",
            "telephone_number": "360-204-1723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 POINDEXTER AVE W",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983124337",
            "telephone_number": "360-204-1723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-23",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": "CG60419820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Keller
• Thomas Ryan Keller
• Randall Grant Kelley, D.O.
• Carolyn Jo Kellogg, ARNP BC
• Bret M Kelly
• Jonathon Luther Kelly, IDC
• Sandra L Kelly, RDH
• Tracy Kendrick
• Kathryn Kennedy, DO
• Kenneth R. Koskella, MD, Inc

• Behavior Technician in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Behavior Technician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; 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.