Active NPI
Kim Marie Kelly, RPH
- Pharmacist
- West Richland, WA
National Provider Identifier
1790119857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00015160
- Practice address
- 1401 Bombing Range Rd
West Richland, WA 99353-8001 - Phone
- (509) 967-8008
- Fax
- (509) 967-8096
- NPI assigned
- Aug 26, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00015160 | WA | Primary |
Addresses
Primary practice location
1401 Bombing Range Rd
West Richland, WA 99353-8001
Mailing address
1401 Bombing Range Rd
West Richland, WA 99353-8001
Phone (509) 967-8008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6029136 | 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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00015160 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1790119857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 BOMBING RANGE RD",
"city": "WEST RICHLAND",
"state": "WA",
"postal_code": "993538001",
"telephone_number": "509-967-8008",
"fax_number": "509-967-8096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 BOMBING RANGE RD",
"city": "WEST RICHLAND",
"state": "WA",
"postal_code": "993538001",
"telephone_number": "509-967-8008",
"fax_number": "509-967-8096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KIM",
"middle_name": "MARIE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-26",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00015160",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6029136",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Richland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.