Provider Demographics
NPI:1669543294
Name:SOWELL, KELLY B (PA C)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:B
Last Name:SOWELL
Suffix:
Gender:M
Credentials:PA C
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Mailing Address - Street 1:500 N RAINBOW BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1084
Mailing Address - Country:US
Mailing Address - Phone:702-259-1228
Mailing Address - Fax:702-259-1252
Practice Address - Street 1:500 N RAINBOW BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1084
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:702-259-1252
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant