Provider Demographics
NPI:1932637949
Name:KELLY, LAUREN ALEXIS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ALEXIS
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 1:73 EASTLAWN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6417
Mailing Address - Country:US
Mailing Address - Phone:203-767-8728
Mailing Address - Fax:
Practice Address - Street 1:126 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7620
Practice Address - Country:US
Practice Address - Phone:203-576-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2017-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program