LISA S. KELLY PA
NPI 1174608806
Physician Assistant in Denver, CO

Q: What is Lisa Kelly's NPI number?

The NPI number for Lisa Kelly is 1174608806. It was assigned to this individual provider in the NPPES registry on October 25, 2006.

Q: What is Lisa Kelly's specialty?

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

Q: Is Lisa Kelly enrolled in Medicare?

No. Lisa Kelly has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Lisa Kelly was last updated on December 3, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.

Active since October 25, 2006Opted out of Medicare · through Jan 1, 2027

777 BANNOCK ST, DENVER, CO 80204(303) 436-6000 Get Directions Write a Review

NPPES record last updated: December 3, 2012. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Lisa S. Kelly Pa NPPES

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

LISA S. KELLY PA (NPI 1174608806) is an individual physician assistant in Denver, Colorado, licensed in Colorado (497) and active in the NPI registry since October 2006. She has opted out of Medicare through January 1, 2027.

NPPES Registry Identity

NPI1174608806

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameLISA S. KELLYCredential: PA

Location Address777 BANNOCK STDenver, CO 80204-4507

Mailing Address777 Bannock StDenver, CO 80204-4507

Phone(303) 436-6000

Sole ProprietorNo

Enumeration DateOctober 25, 2006

Last NPPES UpdateDecember 3, 2012

✔ NPI 1174608806 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 CO · 497

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.

777 BANNOCK ST, Denver, CO 80204

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Other Identifiers 3

Medicaid07004971CO

Medicare ID-Type Unspecified800520

Medicare UPINQ32435

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Lisa S. Kelly Pa 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 January 1, 2021 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2021

Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

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

MS. KATHERINE JEANNE CARLEY RN, MSN, CS

Clinical Nurse Specialist (Psychiatric/Mental Health)