Provider Demographics
NPI:1720412935
Name:WILLEMS, KELLI N (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:N
Last Name:WILLEMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2080 WOODWINDS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2539
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:651-645-6166
Practice Address - Street 1:2080 WOODWINDS DR STE 240
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2539
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-645-6166
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2016-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN11378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant