TAMMY BOYETTE KELLY PA-C NPI 1215267349

NPI Information

NPI: 1215267349
Provider Name: TAMMY BOYETTE KELLY, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
7051 ALVARADO RD
LA MESA, CA
ZIP 91942
Phone: (619) 460-7775
Get Directions

Tammy Boyette Kelly, PA-C is a medical physician assistant in La Mesa, CA. Tammy Boyette Kelly, PA-C NPI is 1215267349. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7051 ALVARADO RD
LA MESA, CA
ZIP 91942-901
Phone: (619) 460-7775

The NPI 1215267349 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/13/2010 and was last updated on 10/26/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA54682	CALIFORNIA	Yes
2	363AM0700X	Physician Assistant	Medical	0010-02138	NORTH CAROLINA	No
3	363AM0700X	Physician Assistant	Medical	PA9107316	FLORIDA	No
4	363AM0700X	Physician Assistant	Medical	0110003655	VIRGINIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1215267349	OTHER		TRICARE/HEALTHNET
2	Y0J7G	OTHER	FLORIDA	BCBS OF FL
3	009498400	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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