MEDICARE: MORGAN BROOKE 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	363AS0400X	Surgical Physician Assistant	58887	CA

General Provider Information

NPI Number	:	1477178184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN BROOKE KELLY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 889442
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90088-0309
Country	:	US
Telephone Number	:	559-603-7372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2473 E FIR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0538
Country	:	US
Telephone Number	:	559-603-7525
Fax Number	:

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	02/21/2025

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