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Individual
ELIZABETH KELLAM
Active
Individual
ELIZABETH KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2484
SC
363A00000X
Physician Assistant
C0005328
MD
363A00000X
Physician Assistant
TL2484
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2464PA
—
SC
Enumeration date
02/12/2014
Last updated
01/27/2021
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