Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MARY KELLY PA
NPI 1912756388
Physician Assistant in Anoka, MN

Active since May 16, 2024
2621 GREENHAVEN RD, ANOKA, MN 55303(952) 967-7075 Get Directions Write a Review

NPPES record last updated: November 2, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Nov 2, 2026, May 16, 2024 (2 updates tracked since 2024).

About Mary Kelly Pa NPPES

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

MARY KELLY PA (NPI 1912756388) is an individual physician assistant in Anoka, Minnesota, licensed in Minnesota (16019) and active in the NPI registry since May 2024.

NPPES Registry Identity

NPI1912756388
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMARY KELLYCredential: PA
Location Address2621 GREENHAVEN RDAnoka, MN 55303-5566
Mailing Address1011 Hesli Hill CtShoreview, MN 55126-1408 · (828) 399-0944
Sole ProprietorYes
Enumeration DateMay 16, 2024
Last NPPES UpdateNovember 2, 20262 updates tracked since enumeration
NPPES CertifiedNovember 2, 2026
✔ NPI 1912756388 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 MN · 16019
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.
2621 GREENHAVEN RD, Anoka, MN 55303

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 15

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

Family Medicine
2621 GREENHAVEN RD
ANOKA, MN 55303
Nurse Practitioner
2621 GREENHAVEN RD
ANOKA, MN 55303
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303
Advanced Practice Midwife
2621 GREENHAVEN RD
ANOKA, MN 55303
Pharmacist
2621 GREENHAVEN RD
ANOKA, MN 55303
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303
Nurse Practitioner
2621 GREENHAVEN RD
ANOKA, MN 55303
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303

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 Mary Kelly's NPI number?

The NPI number for Mary Kelly is 1912756388. It was assigned to this individual provider in the NPPES registry on May 16, 2024.

Where is Mary Kelly located?

Mary Kelly practices at 2621 Greenhaven Rd, Anoka, MN 55303. The listed phone number is (952) 967-7075.

What is Mary Kelly's specialty?

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

When was this NPI record last updated?

The NPPES record for Mary Kelly was last updated on November 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 days 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.