Provider Demographics
NPI:1760951669
Name:CROCI, KELLY ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:CROCI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:ADKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5120 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2321
Mailing Address - Country:US
Mailing Address - Phone:785-408-5800
Mailing Address - Fax:785-730-8700
Practice Address - Street 1:5120 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2321
Practice Address - Country:US
Practice Address - Phone:785-408-5800
Practice Address - Fax:785-730-8700
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant