Provider Demographics
NPI:1679894133
Name:REMY, KELLY JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JAMES
Last Name:REMY
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:12200 BORDEAUX ROAD
Mailing Address - City:LITTLEROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98556-0037
Mailing Address - Country:US
Mailing Address - Phone:360-359-4070
Mailing Address - Fax:
Practice Address - Street 1:7345 LINDERSON WAY SW
Practice Address - Street 2:CEDAR CREEK CORRECTIONS - (RURAL ADDRESS NOT RECOGNIZED
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6504
Practice Address - Country:US
Practice Address - Phone:360-359-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA 10003612363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical