Provider Demographics
NPI:1396224549
Name:SKILES, KELLY (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SKILES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 HANCOCK DR APT 8
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2548
Mailing Address - Country:US
Mailing Address - Phone:608-772-2989
Mailing Address - Fax:
Practice Address - Street 1:13642 RESEARCH BLVD
Practice Address - Street 2:BLDG 2, STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2210
Practice Address - Country:US
Practice Address - Phone:512-331-7300
Practice Address - Fax:512-331-7318
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant