Provider Demographics
NPI:1982860078
Name:AIKIN, KELLE JO (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:JO
Last Name:AIKIN
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:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-1194
Mailing Address - Country:US
Mailing Address - Phone:752-870-6527
Mailing Address - Fax:
Practice Address - Street 1:6940 SIERRA CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2209
Practice Address - Country:US
Practice Address - Phone:775-393-2200
Practice Address - Fax:775-851-1456
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11994056OtherCAQH
NVBB710ZMedicare PIN
11994056OtherCAQH