Individual
KELLIE ACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75-5995 KUAKINI HWY STE 513, KAILUA KONA, HI 96740-2124
(808) 365-2297
Mailing address
75-127 LUNAPULE RD STE 7E, KAILUA KONA, HI 96740-2119
(808) 640-2660
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
AMD-1055
HI
363AM0700X
Medical Physician Assistant
Primary
AMD-1055
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMD-1055
HAWAII PA LICENSE
HI
Enumeration date
01/03/2016
Last updated
04/07/2025
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