Provider Demographics
NPI:1295425213
Name:SARGENT, KELLY ROSE (PA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1 GRIFFIN RD APT 3
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-1701
Mailing Address - Country:US
Mailing Address - Phone:603-325-5736
Mailing Address - Fax:
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-933-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-10-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant