Provider Demographics
NPI:1861970592
Name:OKRAY, KELLY JEAN (PA-C, MSPAS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:OKRAY
Suffix:
Gender:F
Credentials:PA-C, MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38440 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4498
Mailing Address - Country:US
Mailing Address - Phone:661-575-2725
Mailing Address - Fax:
Practice Address - Street 1:38440 5TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4498
Practice Address - Country:US
Practice Address - Phone:661-575-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12756363A00000X
CA58804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant