Kaitlin M Kelly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA60796422 Issued in WA

Practice address

4700 Point Fosdick Dr Ste 102
Gig Harbor, WA 98335-1706

Phone

(253) 853-2050

Fax

(253) 853-2711

NPI assigned

Sep 5, 2017

Last updated

Oct 26, 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 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkelly1042108@wm.providencedirect.org
• Direct secure messaging: kkelly639470@fhsce.catholichealth.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health & Services- Washington

  dba PMG NW Wa

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment Care Compare group NPD
• Swedish Health Services

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1831139724
  Medicare reassignment
• Providence Health & Services - Washington

  dba PMG NW WA In Home Primary Care/Clearview

  • General Practice Physician
  • Snohomish, WA
  • NPI 1770877227
  NPD
• Providence Health & Services - Washington

  dba PMG NW WA Snohomish

  • Family Medicine Physician
  • Snohomish, WA
  • NPI 1982855375
  NPD

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1972021434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR STE 102",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-853-2050",
            "fax_number": "253-853-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR STE 102",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-853-2050",
            "fax_number": "253-853-2711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7136 Meadow Trce",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611148177",
            "country_code": "US",
            "telephone_number": "815-601-9805",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15585 NE 24th St",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980073836",
            "country_code": "US",
            "telephone_number": "888-227-3312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KAITLIN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60796422",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60796422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2088986",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkelly639470@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4700 Point Fosdick Dr Ste 102",
            "city": "Gig Harbor",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983351706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John A. Keech Jr., D.O.
• Keiko J Wada DMD
• Keith Gressell DMD PLLC
• Maureen Elizabeth Kelley, LMP
• Colleen Patricia Kelly
• Lisa H Kelly, PT
• Kelsey Roth Counseling Services, PLLC
• Kelsey Weiland LMP
• Laurel C Kelso, LCSW
• Tonja Lynn Kendrick, LMFT

• Medical Physician Assistant in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.
• 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.