Provider Demographics
NPI:1124188826
Name:HAWS, KELLY KRISTINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KRISTINE
Last Name:HAWS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94027-4110
Mailing Address - Country:US
Mailing Address - Phone:650-325-1395
Mailing Address - Fax:650-325-2019
Practice Address - Street 1:1706 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94027-4110
Practice Address - Country:US
Practice Address - Phone:650-325-1395
Practice Address - Fax:650-325-2019
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16150363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical