Provider Demographics
NPI:1942488499
Name:MCADAMS, KELLIE A (PA)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:MCADAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:A
Other - Last Name:POWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9850 GENESEE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1208
Mailing Address - Country:US
Mailing Address - Phone:858-554-1212
Mailing Address - Fax:858-795-1195
Practice Address - Street 1:3900 5TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3198
Practice Address - Country:US
Practice Address - Phone:858-554-1212
Practice Address - Fax:858-795-1195
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003543363AM0700X
TXPA08877363AM0700X
CAPA59987363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical