Provider Demographics
NPI:1285841981
Name:RABE, KELLY JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:RABE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4887
Practice Address - Fax:651-254-1603
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN11459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant