ANDREA MALUTA KELLY (NPI# 1689956641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689956641 |
| Entity Type | Individual |
| Full Name | ANDREA MALUTA KELLY |
| Other Name | ANDREA MALUTA |
| Credential | P.A. |
| Practice Address |
2015 Randolph Rd Ste 208 Charlotte NC 28207-1241 |
| Mailing Address |
13808 Professional Center Dr Ste 302 Huntersville NC 28078-7948 |
| Practice Telephone | 7043774009 |
| Mailing Telephone | 7043774009 |
| Mailing Fax Number | 7046024381 |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2019-11-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 001004126 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 2531PA | 05 | |
| NC | 1689956641 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952874752 | Andrea A Kelly | Marriage & Family Therapist | 1680 Stone Canyon Dr, Roseville, CA 95661-4041 | 2019-01-04 |
| 1487935516 | Andrea Lee Kelly | Psychologist | 444 South Union St., Suite 230, Burlington, VT 05401 | 2011-09-02 |
| 1104135979 | Andrea W Kelly | Registered Nurse | 704 Old Lilesville Road, Wadesboro, NC 28170-2820 | 2010-09-28 |
| 1023098811 | Andrea Kelly | Dentist | 2908 Auburn Rd, Huntington, WV 25704-2715 | 2006-01-19 |
| 1730533019 | Andrea Kelly | Recreation Therapist | 1400 Noyes St, Utica, NY 13502-3854 | 2016-04-22 |
| 1962830737 | Andrea Kelly | Physical Therapist | 100 Sprunt St, Chapel Hill, NC 27517-7811 | 2013-10-14 |
| 1891050720 | Andrea Isabel Kelly | Behavioral Analyst | 11240 Waples Mill Road, Suite 102, Fairfax, VA 22030 | 2012-07-06 |
| 1720096225 | Andrea Kelly | Pediatrics | 3401 Civic Center Blvd, Children's Hospital of Philadelphia - Endocrinology, Philadelphia, PA 19104-4319 | 2006-08-03 |
| 1528080363 | Andrea Kelly | Specialist | 75 Francis St, Boston, MA 02115-6110 | 2006-07-24 |
| Street Address |
2015 RANDOLPH RD STE 208 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-1241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932671591 | Amanda Jean Muller | Nurse Practitioner | 2015 Randolph Rd Ste 208, Charlotte, NC 28207-1200 | 2018-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| 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 |
|---|---|---|---|---|
| 1396351607 | Michael James Blackwell | Physician Assistant | 501 Billingsley Rd Ste B, Charlotte, NC 28211-1009 | 2020-09-22 |
| 1598371320 | Jonathan Byron Lively | Physician Assistant | 1000 Blythe Blvd Fl 3, Charlotte, NC 28203-5812 | 2020-09-17 |
| 1902415532 | Jacqueline Ellen Leyrer | Physician Assistant | 2630 E 7th St Ste 200, Charlotte, NC 28204-4319 | 2020-07-29 |
| 1750908380 | Whitney Debroy | Physician Assistant | 125 W Tremont Ave Unit 726, Charlotte, NC 28203-5551 | 2020-06-30 |
| 1972129302 | Ashley Nicole Short | Physician Assistant | 1022 E Worthington Ave, Charlotte, NC 28203-5760 | 2020-06-22 |
| 1558985176 | Courtney Claugus | Physician Assistant | 300 E Park Ave Unit 7, Charlotte, NC 28203-4774 | 2020-05-29 |
| 1467071738 | Patrick James Quinn | Physician Assistant | 2036 Millerton Ave Apt 4311, Charlotte, NC 28208-5290 | 2020-04-15 |
| 1225660301 | Sunil Ranchhod Ghodasara | Physician Assistant | 1001 Blythe Blvd Ste 403, Charlotte, NC 28203-5863 | 2020-02-06 |
| 1225668601 | Emily Rebecca Markey | Physician Assistant | 355 W Mlk Blvd Apt 1112, Charlotte, NC 28202-0043 | 2020-01-24 |
| 1639719586 | Abosede Elizabeth Adamson | Physician Assistant | 3101 Amesbury Hill Dr, Charlotte, NC 28269-8951 | 2020-01-08 |
| Find all providers in CHARLOTTE | ||||
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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.