Kelly Lynn Cole, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103309 Issued in FL

Practice address

1034 NW 57TH St
Gainesville, FL 32605-4482

Phone

(352) 519-5430

Fax

(352) 333-6249

NPI assigned

Oct 25, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Doctors Radiology Group of Gainesville LLC

  • Diagnostic Radiology Physician
  • Gainesville, FL
  • NPI 1194775783
  NPD (past)

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1285624932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 NW 57TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054482",
            "telephone_number": "352-519-5430",
            "fax_number": "352-333-6249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 NW 57TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054482",
            "telephone_number": "352-519-5430",
            "fax_number": "352-333-6249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292173100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colasante Clinic,PA
• Ona Colasante, MD
• Brian Mark Colburn, PA-C
• Conrad R Cole, MD
• Dwayne Cole
• Nancy Singletary Cole, PAC
• Angel Coleman
• Conner Coleman, PTA
• Hannah Mary Elizabeth Coleman, PA-C
• Hannah Poole Coleman, CCC-SLP

• Physician Assistant in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.