MEDICARE: KELLI HUMMEL 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	2021037220	MO

General Provider Information

NPI Number	:	1750912028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI HUMMEL PA-C

Provider Business Mailing Address
First Line	:	8855 N CONGRESS AVE APT 311
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1881
Country	:	US
Telephone Number	:	816-825-1268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 DIAMOND PKWY
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-4328
Country	:	US
Telephone Number	:	816-561-3003
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/19/2022

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