NPI 1548635014 · live from the CMS NPI Registry
Kelly Eli Daugherty, PA-C
Physician Assistant in Owatonna, MN. National Provider Identifier 1548635014, active.
NPI record
| NPI | 1548635014 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 2200 Nw 26th St, Owatonna, MN 55060 |
| Practice phone | 507-451-1120 |
| Enumerated | December 9, 2015 |
| Last updated | February 9, 2024 |
| Sole proprietor | No |
| Other names | Kelly Widiger |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | — |
| Physician Assistant, Surgical | 363AS0400X | PAC0622 (ND) |
| Physician Assistant primary | 363A00000X | 12173 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.