Individual
KELLY DALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
131 ROUTE 70 STE 100A, MEDFORD, NJ 08055-9501
(609) 267-9400
(609) 451-5518
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00300900
NJ
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/27/2012
Last updated
02/26/2026
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