Provider Demographics
NPI:1619636834
Name:RAFFERTY, KELSEY (CAA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ATNIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:1035 DOCKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6703
Mailing Address - Country:US
Mailing Address - Phone:920-264-2992
Mailing Address - Fax:
Practice Address - Street 1:9330 FL-54
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-3465
Practice Address - Country:US
Practice Address - Phone:727-834-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant