Active NPI
Kelcey P Rhodes, DDS
- Dentist
- Puyallup, WA
National Provider Identifier
1679803753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11021
- Practice address
- 111 W Main
Puyallup, WA 98371-5331 - Phone
- (253) 845-0520
- Fax
- (253) 770-8643
- NPI assigned
- Jan 12, 2010
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 11021 | WA | Primary |
Addresses
Primary practice location
111 W Main
Puyallup, WA 98371-5331
Mailing address
111 W Main
Puyallup, WA 98371-5331
Phone (253) 845-0520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 11, 2016 through Feb 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11021 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1679803753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 W MAIN",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983715331",
"telephone_number": "253-845-0520",
"fax_number": "253-770-8643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W MAIN",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983715331",
"telephone_number": "253-845-0520",
"fax_number": "253-770-8643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RHODES",
"first_name": "KELCEY",
"middle_name": "P",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-12",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "11021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
- Revitalize and Restore Therapy (Rachael Jordan)
- Nikolaas Enrique Reyna, DDS
- Levi Reynolds, DDS
- Nancy Reynolds, RN
- Rhonda Rayleen Rhoades, MA, LMHC, CTMH
- Thomas Charles Rhodes, DDS
- Richard DO, PLLC (Richard Do, O.D.)
- Susan Carol Richards, LMP
- Ashley Richardson, MOT, OTR/L
- Jacquelyn Monique Richardson, BSN,RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.