Provider Demographics
NPI:1932942133
Name:SUAREZ, KELLYANNE MARGARET (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLYANNE
Middle Name:MARGARET
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73206 E 279 PR NE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7786
Mailing Address - Country:US
Mailing Address - Phone:253-576-6557
Mailing Address - Fax:
Practice Address - Street 1:73206 E 279 PR NE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7786
Practice Address - Country:US
Practice Address - Phone:253-576-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61548299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily