Kelly R Ridge, PAC
Physician Assistant, Surgical in Brockton, Massachusetts
1992789739- Practice location
- 680 Centre St, Brockton, MA 02302-3308
- Phone
- 508-941-7000
- Fax
- —
- Last updated
- February 10, 2025
Kelly R Ridge is a Physician Assistant, Surgical based in Brockton, MA. Kelly R Ridge practices in Brockton, MA and has the professional credentials of PAC. The NPI Number for Kelly R Ridge is 1992789739 and holds a License No. 1104 (MA). The current practice location address for Kelly R Ridge is 680 Centre St, Brockton, MA 02302-3308 and can be reached out via phone at 508-941-7000.
Provider Profile Details
- NPI Number
- 1992789739
- Provider Name
- Kelly R Ridge
- Credential
- PAC
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 680 Centre St, Brockton, MA 02302-3308
- Phone Number
- 508-941-7000
- Primary Taxonomy
- Physician Assistant, Surgical · 363AS0400X
- Sole Proprietor
- No
- Provider Enumeration Date
- December 5, 2005
- Last Update Date
- February 10, 2025
- Certification Date
- February 10, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 680 Centre St
Brockton, MA 02302-3308 - City
- Brockton
- State
- Massachusetts
- Zip
- 02302-3308
- Phone Number
- 508-941-7000
Provider Business Mailing Address Details
- Address
- 3 Washington St
Ste 200
North Easton, MA 02356-1010 - City
- North Easton
- State
- MA
- Zip
- 02356-1010
- Phone Number
- 508-205-9630
- Fax Number
- 508-796-2610
License Information
- License Number
- 1104
- License State
- MA
- Taxonomy
- Physician Assistant, Surgical · 363AS0400X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Kelly R Ridge, PAC?
The NPI number of Kelly R Ridge, PAC is 1992789739. It was assigned on December 5, 2005 and is currently active in the NPPES registry.
What is the specialty of Kelly R Ridge, PAC?
Kelly R Ridge, PAC is registered under the primary taxonomy Physician Assistant, Surgical (code 363AS0400X), licensed in MA under license number 1104.
Where does Kelly R Ridge, PAC practice?
The practice location is 680 Centre St, Brockton, MA 02302-3308. The office can be reached at 508-941-7000 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1992789739 directly on the NPPES registry website.