| Doctor Name: | KEVIN RYAN KELLOGG |
| NPI Number: | 1003899493 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA10005240 |
| Business Practice Address: | 16528 Desmet Ct Spokane Valley, WA - 992163522 |
| Business Phone Number: | 5099448920 |
| Business Fax Number: | 5092277070 |
| Mailing Address: | Po Box 421, LIBERTY LAKE |
| State: | WA |
| Postal Code: | 990190421 |
| Phone Number: | 5096242313 |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2005 |
| NPI Last Update Date: | 10/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA10005240 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |