Provider Demographics
NPI:1508141664
Name:THELIN, KELLY ALLISON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ALLISON
Last Name:THELIN
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 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:202-660-0005
Mailing Address - Fax:202-660-0025
Practice Address - Street 1:1001 G ST NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4545
Practice Address - Country:US
Practice Address - Phone:202-660-0005
Practice Address - Fax:202-660-0025
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030796363A00000X
MDC0004602363A00000X
VA0110003683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant