Provider Demographics
NPI:1326836099
Name:KELLEY, FREEDOM D
Entity type:Individual
Prefix:
First Name:FREEDOM
Middle Name:D
Last Name:KELLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BELL ST APT 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-3612
Mailing Address - Country:US
Mailing Address - Phone:907-306-7504
Mailing Address - Fax:
Practice Address - Street 1:66 BELL ST APT 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-3612
Practice Address - Country:US
Practice Address - Phone:907-306-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program