Provider Demographics
NPI:1972238863
Name:BELLINGHAM BAY FOOT AND ANKLE SPECIALISTS
Entity type:Organization
Organization Name:BELLINGHAM BAY FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLYLER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, AGACNP
Authorized Official - Phone:360-733-3710
Mailing Address - Street 1:1600 F ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3012
Mailing Address - Country:US
Mailing Address - Phone:360-733-3710
Mailing Address - Fax:360-733-7906
Practice Address - Street 1:1600 F ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3012
Practice Address - Country:US
Practice Address - Phone:360-733-3710
Practice Address - Fax:360-733-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty