Provider Demographics
NPI:1518246198
Name:HANCOCK, KELLI SHEA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:SHEA
Last Name:HANCOCK
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 1:4310 JAMES CASEY ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1251
Mailing Address - Country:US
Mailing Address - Phone:512-448-4588
Mailing Address - Fax:
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1251
Practice Address - Country:US
Practice Address - Phone:512-448-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant