MEDICARE: MS. KELLEY ANNE ELLSWORTH 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	PA031761	DC
2	363A00000X	Physician Assistant	PA7445	MA

General Provider Information

NPI Number	:	1710541487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLEY ANNE ELLSWORTH PA-C

Provider Business Mailing Address
First Line	:	3135 38TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3726
Country	:	US
Telephone Number	:	202-744-4983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 NEW MEXICO AVE NW STE 205
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3627
Country	:	US
Telephone Number	:	202-243-2500
Fax Number	:

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

Provider Enumeration Date	:	04/27/2019
Last Update Date	:	06/15/2022

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Directions to “ MS. KELLEY ANNE ELLSWORTH PA-C” Practice Location

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