Kelsey E Dougherty, PA, MMSC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.0004227 Issued in CO

Practice address

12605 E 16TH Ave
Aurora, CO 80045-2545

Phone

(720) 848-0000

NPI assigned

Feb 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelsey Moore Former name

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• University Physicians Incorporated

  • Internal Medicine Physician
  • Aurora, CO
  • NPI 1962461889

  Physician Assistant

  Medicare reassignment NPD (past)
• University Physicians, Incorporated

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Denver, CO
  • NPI 1275045049
  NPD
• University Physicians, Incorporated

  • Internal Medicine Physician
  • Lone Tree, CO
  • NPI 1396257143
  NPD

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1679847560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12605 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800452545",
            "telephone_number": "720-848-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1635 Aurora Ct",
            "address_2": "MS B-163",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452541",
            "country_code": "US",
            "telephone_number": "720-848-0192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "KELSEY",
        "middle_name": "E",
        "credential": "PA, MMSC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-24",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4364",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "MOORE",
            "credential": "PA, MMSC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lauren Dossett
• Kurtis Michael Dostal, MD
• Lauren Hummel Doty, CPNP-PC
• Colleen T Dougherty-Gray, FNP
• Diana Dougherty, LPN
• Marilyn A Dougherty, M.D.
• Michael D Dougherty, D.D.S.
• Sarah L Dougherty
• Douglas County Christian Counseling Inc.
• Adriana Douglas

• Medical Physician Assistant in Aurora, CO
• Providers in Aurora, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; 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.