| Doctor Name: | MRS. COURTNEY ANN KELLY |
| NPI Number: | 1265628275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085003055 |
| Business Practice Address: | 350 Surryse Rd Suite 100 Lake Zurich, IL - 600473217 |
| Business Phone Number: | 8474382144 |
| Business Fax Number: | 8477190335 |
| Mailing Address: | 350 Surryse Rd, Suite 100 LAKE ZURICH |
| State: | IL |
| Postal Code: | 600473217 |
| Phone Number: | 8474382144 |
| Fax Number: | 8477190335 |
| NPI Enumeration Date: | 09/24/2007 |
| NPI Last Update Date: | 09/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085003055 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |