Provider Demographics
NPI:1437188943
Name:KELSEY, AMY O'SHEA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:O'SHEA
Last Name:KELSEY
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 1:2400 D ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3004
Mailing Address - Country:US
Mailing Address - Phone:916-662-4088
Mailing Address - Fax:916-734-3066
Practice Address - Street 1:2221 STOCKTON BLVD
Practice Address - Street 2:SUITE 2112
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1418
Practice Address - Country:US
Practice Address - Phone:916-734-3861
Practice Address - Fax:916-734-3066
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18096363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ55368Medicare UPIN
CA0PA180960Medicare ID - Type UnspecifiedMEDICARE ID NUMBER