Kelly Mitzen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002992 Issued in VA

Practice address

401 Carpenter Rd
Fort Myer, VA 22211-1009

Phone

(703) 966-7935

NPI assigned

Jan 30, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1073584777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CARPENTER RD",
            "city": "FORT MYER",
            "state": "VA",
            "postal_code": "222111009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CARPENTER RD",
            "city": "FORT MYER",
            "state": "VA",
            "postal_code": "222111009",
            "telephone_number": "703-966-7935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITZEN",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1073584777",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annmarie McBride
• Sara Greene McCauley, LCSW
• Alexander McCready
• Ann Stewart McKenney, MD
• Shirley Becton McKenzie, PPCNP-BC
• Kisuk K Moore, RN
• Liliana Alexandra Moreno Santander
• Daniel Patrick Morgan, DO
• Kathryn Nicole Morrill, LICSW
• Rajalakshmi Natarajan, M.D.

• Medical Physician Assistant in Fort Myer, VA
• Providers in Fort Myer, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.