Provider Demographics
NPI:1295837888
Name:WOOD, KELLY JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:JAMES
Last Name:WOOD
Suffix:
Gender:M
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 1:280 N 1275 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-4018
Mailing Address - Country:US
Mailing Address - Phone:801-544-9714
Mailing Address - Fax:
Practice Address - Street 1:20 W 1700 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84016-6004
Practice Address - Country:US
Practice Address - Phone:801-416-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT216216-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical