Provider Demographics
NPI:1023811270
Name:KELLY, KAITLYN NICOLE (PA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:NICOLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:405 WRIGLEY FIELD DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4650
Mailing Address - Country:US
Mailing Address - Phone:912-398-3939
Mailing Address - Fax:
Practice Address - Street 1:1571 HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-5214
Practice Address - Country:US
Practice Address - Phone:912-754-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant