Angela White Kelley, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9105288 Issued in FL

Practice address

1990 N Prospect Ave
Lecanto, FL 34461-9792

Phone

(352) 527-6888

Fax

(352) 527-6888

NPI assigned

Apr 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1255397501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 N PROSPECT AVE",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619792",
            "telephone_number": "352-527-6888",
            "fax_number": "352-527-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 N PROSPECT AVE",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619792",
            "telephone_number": "352-527-6888",
            "fax_number": "352-527-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "ANGELA",
        "middle_name": "WHITE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA0000001010",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3663478",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loribeth Crimson Jones, NP
• Elizabeth Doyle Jordan, MASSAGE THERAPIST
• Sandra Ann Jugov, OTR/L
• Stephen J Kauffman, DPM
• Christopher Aaron Keen, MD
• Christina Lynn Kelley, LCSW
• Kelly Sieg Incorporated
• Kathleen Ann Kinney, LMHC
• Tricia Kisiday, MS OTR/L
• Mark Joseph Knapp, MD

• Medical Physician Assistant in Lecanto, FL
• Providers in Lecanto, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.