MICHAEL TIMOTHY KELLEY M.S. PA-C NPI 1073571816

NPI Information

NPI: 1073571816
Provider Name: MICHAEL TIMOTHY KELLEY, M.S. PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
6625 S RURAL RD STE 104
TEMPE, AZ
ZIP 85283
Phone: (480) 833-4515
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Michael Timothy Kelley, M.S. PA-C is a surgical physician assistant in Tempe, AZ with 29 years of experience. Michael Timothy Kelley, M.S. PA-C NPI is 1073571816. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6625 S RURAL RD STE 104
TEMPE, AZ
ZIP 85283-717
Phone: (480) 833-4515
Fax: (480) 833-5078

The NPI 1073571816 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 5/2/2006 and was last updated on 8/8/2023.

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	363AS0400X	Physician Assistant	Surgical			No
2	363AS0400X	Physician Assistant	Surgical	AZ3829	ARIZONA	Yes

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	AZ3829	OTHER	ARIZONA	ARIZONA STATE LICENSE NUMBER
2	585950	MEDICAID	ARIZONA

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: 5/5/2024

NPI Synchronization or Removal

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