Kelsey Burnett, PA-C
Individual provider Active NPI Physician Assistant · Blackwell, OK
NPI 1275959314 · NPPES record last updated Mar 13, 2014
Key facts
- NPI
- 1275959314
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2382 (OK)
- Practice address
- 1009 W Ferguson Ave
Blackwell, OK 74631-5602 - Phone
- (580) 363-0052
- NPI assigned
- Mar 13, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- AMC Urgent Care Plus LLC
Practice addresses (Care Compare)
2101 N 14TH St
Ponca City, OK 74601-1807
Phone (580) 762-2366
Hospital & facility affiliations
- Integris Health Ponca City
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140818000811 | OK | Practitioner - Physician Assistant | 3274750153 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2382 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Triad Complete Healthcare A06 LLC | Past | Accepting new patients |
Interoperability endpoints
- kelsey.burnett.1@31440.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2382 | OK | Yes |
Addresses
Primary practice location
1009 W Ferguson Ave
Blackwell, OK 74631-5602
Mailing address
1009 W Ferguson Ave
Blackwell, OK 74631-5602
Phone (580) 363-0052
Other providers in Blackwell, OK
- Blackwell Vision Center Inc
- Jeffrey S Blanton
- Paul A. Briggs
- Rebecca Marcelle Bristow
- Samuel David Bryner
- Nita L Calvin
- Joby V Chambers
- Michelle Chan
- Amanda Kay Childers
- City of Blackwell
All providers in Blackwell, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.