Provider Demographics
NPI:1154631810
Name:GUERRA, KELLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:GUERRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY HC - ROCK ISLAND ARSENAL HEALTH CLINIC (RIAHC)
Mailing Address - Street 2:ATTN: MCXM-DMC, BLDG. 110 (BASEMENT)
Mailing Address - City:ROCK ISLAND ARSENAL
Mailing Address - State:IL
Mailing Address - Zip Code:61299-7240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY HC - ROCK ISLAND ARSENAL HEALTH CLINIC (RIAHC)
Practice Address - Street 2:ATTN: MCXM-DMC, BLDG. 110 (BASEMENT)
Practice Address - City:ROCK ISLAND ARSENAL
Practice Address - State:IL
Practice Address - Zip Code:61299
Practice Address - Country:US
Practice Address - Phone:309-782-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
LA1092284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant