Provider Demographics
NPI:1962289645
Name:SOMMERS, KELLY ANN (PA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4761 DON RICARDO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2812
Mailing Address - Country:US
Mailing Address - Phone:713-838-5996
Mailing Address - Fax:
Practice Address - Street 1:8741 ALDEN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3692
Practice Address - Country:US
Practice Address - Phone:310-652-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant