Provider Demographics
NPI:1083314777
Name:KELLY, KENDALL (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6870 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-3781
Mailing Address - Country:US
Mailing Address - Phone:916-248-9031
Mailing Address - Fax:
Practice Address - Street 1:2222 S 16TH ST STE 405B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-481-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant