MEDICARE: MAKENA LORYN KELLY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1093306169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENA LORYN KELLY PA-C

Provider Business Mailing Address
First Line	:	1427 E 12TH AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-3527
Country	:	US
Telephone Number	:	541-591-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	13424 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2759
Country	:	US
Telephone Number	:	509-462-2275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	07/31/2025

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