Provider Demographics
NPI:1922019488
Name:SMOLARZ, KELLI HARGRAVE (PA-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:HARGRAVE
Last Name:SMOLARZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:BROOKE
Other - Last Name:HARGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:STE 308
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3132
Mailing Address - Country:US
Mailing Address - Phone:340-774-8881
Mailing Address - Fax:340-774-1569
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:STE 308
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3132
Practice Address - Country:US
Practice Address - Phone:340-774-8881
Practice Address - Fax:340-774-1569
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04179363A00000X
VI027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant