Provider Demographics
NPI:1962872937
Name:PRADO, KELLEY (PA-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:PRADO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 SW 7TH ST STE A205
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2983
Mailing Address - Country:US
Mailing Address - Phone:703-590-5999
Mailing Address - Fax:703-590-5399
Practice Address - Street 1:13168 CENTERPOINTE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5287
Practice Address - Country:US
Practice Address - Phone:703-730-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant