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General NPI Number Information
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NPI Number | 1134630528
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Entity Type | Individual
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Provider Name | TABITHA KELLY PA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 23900 MILTON ELLENDALE HWY
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City | MILTON
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State | DE
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Zip | 19968-2714
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Country | US
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Telephone | 302-684-5635
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Fax | 866-546-6159
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Provider Business Mailing Address
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Address Line | 1515 SAVANNAH RD FL 2
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City | LEWES
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State | DE
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Zip | 19958-1675
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Country | US
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Telephone | 302-645-3499
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Fax | 302-644-4830
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0012230
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License Number State | DE
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