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General NPI Number Information
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NPI Number | 1053777342
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Entity Type | Individual
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Provider Name | KELLIE ACOSTA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/03/2016
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 75-5995 KUAKINI HWY STE 513
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City | KAILUA KONA
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State | HI
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Zip | 96740-2124
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Country | US
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Telephone | 808-365-2297
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Fax |
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Provider Business Mailing Address
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Address Line | 75-127 LUNAPULE RD STE 7E
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City | KAILUA KONA
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State | HI
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Zip | 96740-2119
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Country | US
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Telephone | 808-640-2660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AMD-1055
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | AMD-1055
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License Number State | HI
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