Provider Demographics
NPI:1003286428
Name:MARTIN, KELLY ANN (MSPA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSPA-C
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:BRISSENDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPA-C
Mailing Address - Street 1:200 LOTHROP STREET
Mailing Address - Street 2:5TH FLOOR, B WING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-648-6531
Mailing Address - Fax:412-647-9207
Practice Address - Street 1:200 LOTHROP STREET
Practice Address - Street 2:FLOOR 9D
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-648-6531
Practice Address - Fax:412-647-9207
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061613363A00000X, 363AM0700X
NY019160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant