Individual provider Active NPI

Kelly G West, PAC

  • Medical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1518145135
Registry record updated Mar 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1716 Issued in OK
Practice address
6161 S Yale Ave
Tulsa, OK 74136-1902
Phone
(918) 494-1805
Fax
(918) 494-4573
NPI assigned
Feb 6, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1716 OK Primary

Addresses

Primary practice location

6161 S Yale Ave
Tulsa, OK 74136-1902

Mailing address

6600 S Yale Ave Ste 1200
Tulsa, OK 74136-3361
Phone (918) 488-6687

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidOK
PENDINGOtherOKRAILROAD MEDICARE

Other names 1

  • Kelly G Pound Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20080404000265 OK Practitioner - Physician Assistant 9335226091 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

6161 S Yale Ave
Tulsa, OK 74136-1902
Phone (918) 502-4720

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3331
Phone (918) 488-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1716OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Warren Clinic Inc CurrentSince Jul 16, 2012 Accepting new patients

Locations

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125

6161 S Yale Ave
#A
Tulsa, OK 74136

6600 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-1805

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520208000000",
    "number": "1518145135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 1200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363361",
            "telephone_number": "918-488-6687",
            "fax_number": "918-488-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361902",
            "telephone_number": "918-494-1805",
            "fax_number": "918-494-4573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEST",
        "first_name": "KELLY",
        "middle_name": "G",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-06",
        "last_updated": "2018-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "PA1716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "PENDING",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "POUND",
            "middle_name": "G",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.