Provider Demographics
NPI:1174957880
Name:PELKEY, MICHELLE A (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:PELKEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 SE MARINE SCIENCE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5300
Mailing Address - Country:US
Mailing Address - Phone:541-867-8823
Mailing Address - Fax:541-867-8856
Practice Address - Street 1:2002 SE MARINE SCIENCE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5300
Practice Address - Country:US
Practice Address - Phone:541-867-8823
Practice Address - Fax:541-867-8856
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1028343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant