Individual
MICHAEL TIMOTHY KELLEY
Active
Individual
MICHAEL TIMOTHY KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
AZ3829
AZ
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
585950
—
AZ
01
—
AZ3829
ARIZONA STATE LICENSE NUMBER
AZ
Enumeration date
05/02/2006
Last updated
08/08/2023
Update your record
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