Provider Demographics
NPI:1598456790
Name:RAFFERTY, KELSEY S (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:S
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:S
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2121 RED BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8095
Mailing Address - Country:US
Mailing Address - Phone:775-843-6018
Mailing Address - Fax:
Practice Address - Street 1:491 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1708
Practice Address - Country:US
Practice Address - Phone:775-525-8103
Practice Address - Fax:775-525-8105
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA3112363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical