Provider Demographics
NPI:1881872463
Name:ADSERO, KELLY JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEAN
Last Name:ADSERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:SUTIE 403
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3987
Mailing Address - Country:US
Mailing Address - Phone:206-784-8833
Mailing Address - Fax:206-784-0676
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:SUITE 403
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3987
Practice Address - Country:US
Practice Address - Phone:206-784-8833
Practice Address - Fax:206-784-0676
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant