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General NPI Number Information
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NPI Number | 1285455501
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Entity Type | Individual
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Provider Name | KELSIE LYNNE HILTY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 4735 HAMILTON AVE STE 80
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City | SAN JOSE
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State | CA
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Zip | 95130-1769
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Country | US
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Telephone | 214-404-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 1059 MOONGATE PL
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City | SAN JOSE
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State | CA
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Zip | 95120-2031
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Country | US
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Telephone | 214-404-5177
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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 | 652262
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License Number State | CA
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