Provider Demographics
NPI:1528470341
Name:KELLY, JOHN CURTIS (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CURTIS
Last Name:KELLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 CURVE CREST BLVD W STE 104
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6181
Mailing Address - Country:US
Mailing Address - Phone:651-439-8807
Mailing Address - Fax:652-439-0232
Practice Address - Street 1:1701 CURVE CREST BLVD W STE 104
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6181
Practice Address - Country:US
Practice Address - Phone:651-439-8807
Practice Address - Fax:652-439-0232
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-005039363A00000X
MN13315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant