Provider Demographics
NPI:1669117636
Name:KELLY, MICHAELA BEATRIE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:BEATRIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:193 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7353
Mailing Address - Country:US
Mailing Address - Phone:781-879-0979
Mailing Address - Fax:
Practice Address - Street 1:885 UNION ST STE 145
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3073
Practice Address - Country:US
Practice Address - Phone:207-973-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant