MEDICARE: KELLEY FOGARTY MCGEE 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	PA9105076	FL

General Provider Information

NPI Number	:	1932332905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY FOGARTY MCGEE PA-C

Provider Business Mailing Address
First Line	:	1355 THOMASWOOD DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-7915
Country	:	US
Telephone Number	:	850-656-4555
Fax Number	:	850-656-4557

Provider Business Practice Location Address
First Line	:	1355 THOMASWOOD DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-7915
Country	:	US
Telephone Number	:	850-656-4555
Fax Number	:	850-656-4557

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	10/10/2011

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