Provider Demographics
NPI:1497829998
Name:KELLY, MEGHAN ANNE (PA)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:275 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1106
Practice Address - Country:US
Practice Address - Phone:408-362-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant