Provider Demographics
NPI:1750707998
Name:MYRICK, KELSEY ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:MYRICK
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:332 SANTA FE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5143
Mailing Address - Country:US
Mailing Address - Phone:760-943-6700
Mailing Address - Fax:760-632-4254
Practice Address - Street 1:332 SANTA FE DR STE 110
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5143
Practice Address - Country:US
Practice Address - Phone:760-943-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant