Provider Demographics
NPI:1578095287
Name:LAWSON, KELLY L (ARNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:LAWSON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PARFITT WAY SW STE N285
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4925
Mailing Address - Country:US
Mailing Address - Phone:206-504-3784
Mailing Address - Fax:206-385-5825
Practice Address - Street 1:175 PARFITT WAY SW STE N285
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4925
Practice Address - Country:US
Practice Address - Phone:206-504-3784
Practice Address - Fax:206-385-5825
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60763392363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner