| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KELLY R MINIHANE | 1487622205 | 2006-03-08 |
Kelly R Minihane is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1487622205. Registration indicates Kelly R Minihane is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Ms. Kelly R Minihane PA-C |
| Other Provider Name | Kelly R Mcmahan |
| Practice Office Address | 3027 N CIRCLE DR COLORADO SPRING, CO US |
| Practice Office Telephone | 7197763216 |
| Practice Office Fax | 7197763220 |
| Mailing Address | 3027 N CIRCLE DR COLORADO SPRINGS, CO 809091179 US |
| Business Telephone | 7197763216 |
| Business Fax | 7197763220 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 3027 N Circle Dr | Colorado Springs, CO 809091179 | 7197763216 / 7197763220 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 085-003885
IL |
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA.0002078
CO |