Healthcare Provider Details

I. General information

NPI: 1477178184
Provider Name (Legal Business Name): MORGAN BROOKE KELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 E FIR AVE
FRESNO CA
93720-0538
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-0309
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7525
  • Fax:
Mailing address:
  • Phone: 559-603-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number58887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: