Provider Demographics
NPI:1528775053
Name:DUNGAN, KELLY (RN, LM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:RN, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 INGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9564
Mailing Address - Country:US
Mailing Address - Phone:813-966-2166
Mailing Address - Fax:
Practice Address - Street 1:5060 INGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9564
Practice Address - Country:US
Practice Address - Phone:813-966-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60506288163W00000X
WAMW61256005176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse