Provider Demographics
NPI:1548554942
Name:KELJO, AMY ARNOLD (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ARNOLD
Last Name:KELJO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 5TH AVE S
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3886
Mailing Address - Country:US
Mailing Address - Phone:206-462-4859
Mailing Address - Fax:206-223-7926
Practice Address - Street 1:500 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4636
Practice Address - Country:US
Practice Address - Phone:206-470-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60194890363L00000X
WARN60033708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8902069Medicare UPIN