Provider Demographics
NPI:1508230343
Name:KELLY, CARLY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:KELLY
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 1:180 FORT COUCH RD STE 375
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1080
Mailing Address - Country:US
Mailing Address - Phone:412-833-8811
Mailing Address - Fax:
Practice Address - Street 1:180 FORT COUCH RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1041
Practice Address - Country:US
Practice Address - Phone:412-833-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003675363AM0700X
PAMA057969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical