Provider Demographics
NPI:1952311334
Name:O'CONNOR, KELLY JOAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JOAN
Last Name:O'CONNOR
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 1:502 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4048
Mailing Address - Country:US
Mailing Address - Phone:412-727-6766
Mailing Address - Fax:
Practice Address - Street 1:502 FOREST RIDGE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4048
Practice Address - Country:US
Practice Address - Phone:443-994-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant