Provider Demographics
NPI:1689228181
Name:ALO, KELSEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:ALO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:800 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6440
Practice Address - Country:US
Practice Address - Phone:979-207-4000
Practice Address - Fax:979-207-4562
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXPA13935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8PX963OtherBCBS - US MSO
TX8PQ544OtherBCBS - XCITE SURGICAL
TX8PQ840OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TXPA13935OtherTEXAS MEDICAL BOARD
TX8PR464OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8PZ636OtherBCBS - BLUE STAR SURGICAL