Provider Demographics
NPI:1184948135
Name:KELSEY, CARLOS AARON (PA-C)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:AARON
Last Name:KELSEY
Suffix:
Gender:M
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 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:595 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-566-5500
Practice Address - Fax:702-558-7238
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9752751-1206363A00000X
NVPA1310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184948135Medicaid
AZ4610OtherAZ REGULATORY BOARD OF PHYSICIAN ASSISTANTS
NVPA1310OtherSTATE LICENSE