MEDICARE: AUDREY CHRISTINE KELLEY 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	113710	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770977571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY CHRISTINE KELLEY PA-C

Provider Business Mailing Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	877-708-9752
Fax Number	:	907-802-6248

Provider Business Practice Location Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	877-708-9752
Fax Number	:	907-802-6248

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	12/15/2025

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