Provider Demographics
NPI:1245958354
Name:KELLY, OLIVIA MCKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MCKENZIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 DELAWARE AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-220-6990
Mailing Address - Fax:724-550-4158
Practice Address - Street 1:104 DELAWARE AVENUE
Practice Address - Street 2:STE 100
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-220-6990
Practice Address - Fax:724-550-4158
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
PAMAO63872207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty