MEDICARE: KELSEY LEANNE HINES BREWINGTON 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	363AM0700X	Medical Physician Assistant	078	VI

General Provider Information

NPI Number	:	1285121392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY LEANNE HINES BREWINGTON PA-C

Provider Business Mailing Address
First Line	:	3018 ORANGE GROVE
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	340-772-1551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 ORANGE GROVE
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	340-772-1551
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	03/02/2026

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