Randall Grant Kelley, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

003754 Issued in OH

Practice address

Naval Hospital
One Boone Road
Bremerton, WA 98312-1898

Phone

(360) 475-4426

Fax

(360) 475-4344

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366243200000",
    "number": "1841203130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NAVAL HOSPITAL",
            "address_2": "ONE BOONE ROAD",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983121898",
            "telephone_number": "360-475-4426",
            "fax_number": "360-475-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL HOSPITAL",
            "address_2": "ONE BOONE ROAD",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983121898",
            "telephone_number": "360-475-4426",
            "fax_number": "360-475-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "RANDALL",
        "middle_name": "GRANT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2013-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "003754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen A Keck, M.D.
• Emma Pearl Keeling, SUDP-T
• William C Kehl
• Kristi Keller
• Thomas Ryan Keller
• Carolyn Jo Kellogg, ARNP BC
• Bret M Kelly
• John Kelly
• Jonathon Luther Kelly, IDC
• Sandra L Kelly, RDH

• Family Medicine Physician in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.