Kristen Kelly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

025374 Issued in NY

Practice address

31 W Maple Rd
Greenlawn, NY 11740-1024

Phone

(631) 560-7359

NPI assigned

Jul 28, 2020

Last updated

Dec 30, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1922617612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W MAPLE RD",
            "city": "GREENLAWN",
            "state": "NY",
            "postal_code": "117401024",
            "telephone_number": "631-560-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W MAPLE RD",
            "city": "GREENLAWN",
            "state": "NY",
            "postal_code": "117401024",
            "telephone_number": "631-560-7359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KRISTEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025374",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Jaquez, BSN, RN
• Matthew John Johnson, PT, DPT, LAT, ATC
• Juliette Julien, LPN
• Christopher A Junker, P.T.
• Cathryn W Karafa, LSP
• Anne E. Kieran, D.O.
• Kimberly Crocco Inc. (Children's Achievement Network Inc.)
• Paul Korman, RPH
• Irene P Korolczuk, LCSW R
• Suzanne Krishnamoorthy, DO

• Physician Assistant in Greenlawn, NY
• Providers in Greenlawn, NY by specialty
• Physician Assistant in New York

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