Individual
KELLY ONEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13650 E MISSISSIPPI AVE, AURORA, CO 80012-3561
(303) 695-8684
Mailing address
13650 E MISSISSIPPI AVE, AURORA, CO 80012-3561
(303) 695-8684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1038
AK
363A00000X
Physician Assistant
Primary
PA.0003100
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000901753
BLUE CROSS BLUE SHIELD OF MONTANA
MT
05
—
1477799310
—
MT
Enumeration date
12/24/2008
Last updated
01/20/2020
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