Provider Demographics
NPI:1760952345
Name:KELLY, ANNMARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANNMARIE
Middle Name:
Last Name:KELLY
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 1:4735 OGLETOWN STANTON RD STE 3217
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2094
Mailing Address - Country:US
Mailing Address - Phone:302-602-8822
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3217
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2094
Practice Address - Country:US
Practice Address - Phone:302-602-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0012257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant