Nicole Kelly, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9190865-1206 Issued in UT

Practice address

12340 S 450 E
Draper, UT 84020-8154

Phone

(801) 501-9797

NPI assigned

Oct 29, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 13, 2025 through Mar 13, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Biorestoration Medical

  • Family Medicine Physician
  • Draper, UT
  • NPI 1902286297
  NPD (past)
• Freedom Healthcare, LLC

  • General Practice Physician
  • Sandy, UT
  • NPI 1770916306
  NPD (past)
• Quintessence Health and Wellness

  • Pain Medicine (Anesthesiology) Physician
  • Draper, UT
  • NPI 1659974293
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470009600000",
    "number": "1013312339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8899 S 700 E",
            "address_2": "SUITE 250",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840701810",
            "telephone_number": "801-613-2711",
            "fax_number": "801-878-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12340 S 450 E",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840208154",
            "telephone_number": "801-501-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "NICOLE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2016-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "9190865-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaxon Keeler, RBT
• Tiana Keetch
• Mana Keihanian, M.D.
• James Keller
• Rylee Kelley
• Malia Kema
• Amy Kenney, CSW
• Heather Kenworthy
• Rylie Kershaw
• Kelly Kessler

• Physician Assistant in Draper, UT
• Providers in Draper, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.