Provider Demographics
NPI:1558344812
Name:MCKEE, KELLI R (PA-C)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:R
Last Name:MCKEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:R
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 N THUNDERBIRD CIR STE 303
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1219
Mailing Address - Country:US
Mailing Address - Phone:480-455-4932
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:1683 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7921
Practice Address - Country:US
Practice Address - Phone:970-400-7618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY481363AS0400X
CO1735363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01481660OtherRR MEDICARE
CO67156738Medicaid
WYP01492742OtherRR MEDICARE
WYW27252Medicare PIN
COC494538Medicare PIN
CO414714YW01Medicare PIN