Provider Demographics
NPI:1932332905
Name:MCGEE, KELLEY FOGARTY (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:FOGARTY
Last Name:MCGEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1355 THOMASWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7915
Mailing Address - Country:US
Mailing Address - Phone:850-656-4555
Mailing Address - Fax:850-656-4557
Practice Address - Street 1:1355 THOMASWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7915
Practice Address - Country:US
Practice Address - Phone:850-656-4555
Practice Address - Fax:850-656-4557
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant