Provider Demographics
NPI:1861970592
Name:OKRAY, KELLY JEAN (PA-C, MSPAS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:OKRAY
Suffix:
Gender:F
Credentials:PA-C, MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 AMERICAN BLVD W STE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4442
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:1200 CHASKA CREEK WAY STE 200
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2749
Practice Address - Country:US
Practice Address - Phone:952-856-1046
Practice Address - Fax:952-847-4067
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN12756363A00000X
CA58804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant