Provider Demographics
NPI:1194061671
Name:KELLY, SLOAN WARREN (MPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:SLOAN
Middle Name:WARREN
Last Name:KELLY
Suffix:
Gender:M
Credentials:MPAS, PA-C
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:888-683-2778
Mailing Address - Fax:808-433-5460
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:888-683-2778
Practice Address - Fax:808-433-5460
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA08040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant