Provider Demographics
NPI:1972535136
Name:KELLEY, CHRISTOPHER J (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KELLEY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5602 MARQUESAS CIR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3310
Mailing Address - Country:US
Mailing Address - Phone:941-921-7788
Mailing Address - Fax:941-921-3399
Practice Address - Street 1:5602 MARQUESAS CIR
Practice Address - Street 2:SUITE #101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3310
Practice Address - Country:US
Practice Address - Phone:941-921-7788
Practice Address - Fax:941-921-3399
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA9102629363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG69954Medicare UPIN