Tracey Dawn Kelly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2881912 Issued in ID

Practice address

700 W Ironwood Dr Ste 350
Coeur D Alene, ID 83814-4487

Phone

(208) 625-5222

NPI assigned

May 20, 2026

Last updated

Aug 24, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1779235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1184554230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 N VERLAINE DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158110",
            "telephone_number": "208-215-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 350",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144487",
            "telephone_number": "208-625-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Ironwood Dr Ste 341",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838144404",
            "country_code": "US",
            "telephone_number": "208-625-5222",
            "fax_number": "208-625-5223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TRACEY",
        "middle_name": "DAWN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-05-20",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "2881912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darwin Ray Kellicut, MSW
• Raquel Angela Kellicut, MA
• Pamela Kellogg, MSPT
• Amanda Lynn Kelly, DPT
• Caleb Kelly, MD
• Ryan Char Kelm
• Diana Lynn Kelsey, LCPC-5415
• Kathyrn Ann Sumner Kelso, LCPC
• Jeremy Kendall, LPC, QMHP, LAC
• Regina Marie Kendra

• Physician Assistant in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; 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.