Provider Demographics
NPI:1558344812
Name:MCKEE, KELLI R (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:R
Last Name:MCKEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:R
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 N THUNDERBIRD CIR STE 303
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1219
Mailing Address - Country:US
Mailing Address - Phone:480-455-4932
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:2144 MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8402
Practice Address - Country:US
Practice Address - Phone:303-772-0041
Practice Address - Fax:303-772-0042
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1735363A00000X, 363AS0400X
WY481363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67156738Medicaid
COP01481660OtherRR MEDICARE
WYP01492742OtherRR MEDICARE
WYW27252Medicare PIN
COC494538Medicare PIN
CO414714YW01Medicare PIN