Individual
KELLY ELIZABETH GRAVER PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9279 LOCUST ST., JACKSON, CA 95669
(209) 245-6968
(209) 245-5135
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA18164
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0078351
MEDICAL
CA
Enumeration date
08/07/2006
Last updated
02/21/2019
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