Provider Demographics
NPI:1104428275
Name:QUICK, KELSEY LEE (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:QUICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEE
Other - Last Name:JARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:726 PINE DRIFT DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2504
Mailing Address - Country:US
Mailing Address - Phone:301-875-5517
Mailing Address - Fax:
Practice Address - Street 1:33 MAGOTHY BEACH RD STE 102-103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4413
Practice Address - Country:US
Practice Address - Phone:480-939-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007893207VG0400X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty