KELLY ANN BEVILAQUA-TRACY (NPI# 1114179637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114179637 |
| Entity Type | Individual |
| Full Name | KELLY ANN BEVILAQUA-TRACY |
| Credential | PA |
| Practice Address |
390 Pierce St Kingston PA 18704-5532 |
| Practice Telephone | 5702883535 |
| Practice Fax Number | 5702880804 |
| Mailing Telephone | 5702883535 |
| Mailing Fax Number | 5702880804 |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2019-12-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MA053585 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
390 PIERCE ST |
| City | KINGSTON |
| State | PA |
| Zip Code | 18704-5532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417955618 | Carl J. Urbanski | Optometrist | 390 Pierce St, Kingston, PA 18704-5532 | 2005-07-12 |
| 1942782321 | Nayab Davis | Optometrist | 390 Pierce St, Kingston, PA 18704-5532 | 2018-09-03 |
| 1104279850 | Stephanie Grencavage | Nurse Practitioner | 390 Pierce St, Kingston, PA 18704-5532 | 2016-07-18 |
| 1578820668 | Andrews and Verazin Surgical Consultants | Surgery | 390 Pierce St, Kingston, PA 18704-5532 | 2012-04-13 |
| 1780836296 | Steven Milewski | Physician Assistant | 390 Pierce St, Kingston, PA 18704-5532 | 2008-10-15 |
| 1437200367 | William D Hottenstein Md PC | Internal Medicine | 390 Pierce St, Kingston, PA 18704-5532 | 2007-01-16 |
| 1437228020 | Frank O'brien M.d. P.C. | Orthopaedic Surgery | 390 Pierce St, Kingston, PA 18704-5532 | 2006-11-07 |
| 1114939451 | Orthopaedic Consultants of Wyoming Valley LLC | Orthopaedic Surgery | 390 Pierce St, Kingston, PA 18704-5532 | 2006-08-13 |
| 1770595027 | Michael C Raklewicz | Orthopaedic Surgery | 390 Pierce St, Kingston, PA 18704-5532 | 2006-08-13 |
| 1528070778 | James M Mattucci | Orthopaedic Surgery | 390 Pierce St, Kingston, PA 18704-5532 | 2006-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013557552 | Millmark Health Inc. | Psychiatry & Neurology | 511 Pierce Street, Kingston, PA 18704 | 2020-01-13 |
| 1427550334 | Michael Anthony Waltich | Military Health Care Provider | 82 Cooper Street, Pringle, PA 18704 | 2018-03-06 |
| 1376088435 | Jae LLC | Massage Therapist | 512 Northhampton Street, Edwardsville, PA 18704 | 2016-12-28 |
| 1306278288 | Mohammad Khaled Tashkandi | Internal Medicine | 490 Northampton St Ste 1, Edwardsville, PA 18704 | 2013-08-02 |
| 1396180014 | Sammie Craven IIi | Pharmacist | 96 1st Avenue, Kingston, PA 18704 | 2013-05-08 |
| 1447693114 | Catherine Mary Harding | Nurse Practitioner | 141 South Maple Ave, Kingston, PA 18704 | 2013-04-12 |
| 1861781403 | Jennifer Ann Richards | Pharmacist | 22 West Side Mall, Edwardsville, PA 18704 | 2011-04-05 |
| 1558512772 | Jolon Theresa Sherin | Speech-Language Pathologist | 1825 Sans Souci Highway, Hanover, PA 18704 | 2008-10-07 |
| 1932361102 | Kari Ann Pietralczyk | Audiologist | 190 Welles Street, Forty-fort, PA 18704 | 2008-06-30 |
| 1467584151 | John Christopher Storti | Chiropractor | 180 United Penn Plaza, Kingston, PA 18704 | 2007-03-09 |
| Find all providers in zip 18704 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386254456 | Kari Marie Fula | Physician Assistant | 28 Putters Pl, Kingston, MA 02364-4114 | 2020-08-04 |
| 1306316849 | Kelsea Michelle Struski | Physician Assistant | 10 Rosewood Dr, Kingston, MA 02364-2151 | 2018-11-27 |
| 1073010047 | Emily Kelleigh | Physician Assistant | 11560 Ne Skyward Loop, Kingston, WA 98346-7606 | 2018-04-06 |
| 1992810220 | Karl Kruszynski | Physician Assistant | 40 Hurley Ave Ste 10, Kingston, NY 12401-3738 | 2006-08-19 |
| 1417998246 | Kristina Carr | Physician Assistant | 40 Hurley Ave Ste 3, Kingston, NY 12401 | 2006-06-10 |
| 1437124377 | Erin Burns | Physician Assistant | 2 Poplar St, Kingston, PA 18704-3709 | 2006-02-22 |
| 1457341315 | Michelle Cahill | Physician Assistant | 5 Tarkiln Rd, Kingston, MA 02364-1250 | 2005-10-24 |
| 1982220760 | Tyler Edmund Ryman | Physician Assistant | 560 Pierce St, Kingston, PA 18704-5716 | 2020-06-17 |
| 1588140107 | Kathryn E Swanzey | Physician Assistant | 117 Marys Ave Ste 101, Kingston, NY 12401-5849 | 2018-07-17 |
| 1972099646 | Michael Aaron Kurek | Physician Assistant | 396 Broadway, Kingston, NY 12401-4626 | 2018-07-06 |
| Find all providers in KINGSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.