Provider Demographics
NPI:1649640152
Name:KELLY, BRITTANY RAE (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:RAE
Last Name:KELLY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-967-7977
Mailing Address - Fax:651-254-8558
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130
Practice Address - Country:US
Practice Address - Phone:952-967-7977
Practice Address - Fax:651-254-8558
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2018-12-12
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Provider Licenses
StateLicense IDTaxonomies
MN11954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant