Kelly Parker, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9117316 Issued in FL

Practice address

2100 Via Bella Blvd Ste 102
Land O Lakes, FL 34639-5429

Phone

(813) 712-5718

Fax

(813) 355-5029

NPI assigned

Apr 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Kelly Reynolds Former name

Medicare fee-for-service enrollment

Enrolled in NY, FL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ohi West Medical Group II LLCGroup PAC ID 0648631192, 407 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Ohi West Medical Group II LLC

  • General Practice Physician
  • Zephyrhills, FL
  • NPI 1982381299
  Medicare reassignment Care Compare group NPD
• Florida Medical Clinic LLC

  • Clinic/Center
  • Zephyrhills, FL
  • NPI 1821055690
  Medicare reassignment NPD
• Florida Medical Clinic, LLC

  • Pharmacy
  • Zephyrhills, FL
  • NPI 1669548020
  NPD
• Ohi West Medical Group II LLC

  • Durable Medical Equipment & Medical Supplies
  • Wesley Chapel, FL
  • NPI 1427814847
  NPD

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1811459399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQUARE DR",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "352-567-0188",
            "fax_number": "813-355-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 VIA BELLA BLVD STE 102",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346395429",
            "telephone_number": "813-712-5718",
            "fax_number": "813-355-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "025795",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "025795",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9117316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "REYNOLDS",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Land O Lakes, FL
• Providers in Land O Lakes, 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 Jan 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.