Provider Demographics
NPI:1285455501
Name:HILTY, KELSIE LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:LYNNE
Last Name:HILTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 MOONGATE PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2031
Mailing Address - Country:US
Mailing Address - Phone:214-404-5177
Mailing Address - Fax:
Practice Address - Street 1:4735 HAMILTON AVE STE 80
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1769
Practice Address - Country:US
Practice Address - Phone:214-404-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA652262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant