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NICOLE KELLY P.A.-C
NPI 1013312339
Physician Assistant in Draper, UT

Active since October 29, 2014Opted out of Medicare · through Mar 13, 2027
12340 S 450 E, DRAPER, UT 84020(801) 501-9797 Get Directions Write a Review

NPPES record last updated: August 1, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Nicole Kelly P.a.-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE KELLY P.A.-C (NPI 1013312339) is an individual physician assistant in Draper, Utah, licensed in Utah (9190865-1206) and active in the NPI registry since October 2014. She has opted out of Medicare through March 13, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1013312339
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameNICOLE KELLYCredential: P.A.-C
Location Address12340 S 450 EDraper, UT 84020-8154
Mailing Address8899 S 700 E, Suite 250Sandy, UT 84070-1810 · (801) 613-2711 · Fax (801) 878-7507
Phone(801) 501-9797
Sole ProprietorNo
Enumeration DateOctober 29, 2014
Last NPPES UpdateAugust 1, 2016
✔ NPI 1013312339 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in UT · 9190865-1206
Definition
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.
12340 S 450 E, Draper, UT 84020
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Nicole Kelly P.a.-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 13, 2025 through March 13, 2027.

Opt-Out Effective DateMarch 13, 2025
Opt-Out In Effect ThroughMarch 13, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84020 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LAURIE CHILDS PA-C
Physician Assistant (Medical)
12340 S 450 E
DRAPER, UT 84020
Salt Lake County (801) 501-9797
QUINTESSENCE HEALTH AND WELLNESS
Anesthesiology (Pain Medicine)
12340 S 450 E
DRAPER, UT 84020
Salt Lake County (801) 930-9381
BIORESTORATION MEDICAL
Family Medicine
12340 S 450 E
DRAPER, UT 84020
Salt Lake County (801) 501-9797
AMY B. KILLEN M.D.
General Practice
12340 S 450 E
DRAPER, UT 84020
Salt Lake County (801) 501-9797

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Kelly's NPI number?

The NPI number for Nicole Kelly is 1013312339. It was assigned to this individual provider in the NPPES registry on October 29, 2014.

Where is Nicole Kelly located?

Nicole Kelly practices at 12340 S 450 E, Draper, UT 84020. The listed phone number is (801) 501-9797.

What is Nicole Kelly's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Nicole Kelly enrolled in Medicare?

No. Nicole Kelly has opted out of Medicare through March 13, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Nicole Kelly was last updated on August 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.