Healthcare Provider Details

I. General information

NPI: 1306436910
Provider Name (Legal Business Name): KELLI M STANLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 OGDEN AVE STE 160
AURORA IL
60504-4383
US

IV. Provider business mailing address

2000 OGDEN AVE STE P050
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-6440
  • Fax: 630-851-7001
Mailing address:
  • Phone: 630-978-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: