Provider Demographics
NPI:1649608555
Name:WEBB, KELLY (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 PRINCETON PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2325
Mailing Address - Country:US
Mailing Address - Phone:609-896-0444
Mailing Address - Fax:609-587-4349
Practice Address - Street 1:3120 PRINCETON PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2325
Practice Address - Country:US
Practice Address - Phone:609-896-0444
Practice Address - Fax:609-587-4349
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00311600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant