Provider Demographics
NPI:1306365333
Name:LAVOIE, KELLY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:ROBERTSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3525 OLENTANGY RIVER RD STE 4330
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-255-6900
Mailing Address - Fax:
Practice Address - Street 1:3525 OLENTANGY RIVER RD STE 4330
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-255-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant