Provider Demographics
NPI:1124991369
Name:HART, KELLY (ND)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 EVERGREEN WAY APT A223
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4390
Mailing Address - Country:US
Mailing Address - Phone:503-880-3491
Mailing Address - Fax:
Practice Address - Street 1:11030 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3897
Practice Address - Country:US
Practice Address - Phone:503-880-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath