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Amanda Rose Kelly

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

175 Fore River Pkwy, Portland, ME 04102-2779

PECOS Enrollment

This provider is enrolled in PECOS as AMANDA KELLY.

Based on the most recent information from CMS, provider Amanda Rose Kelly is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1881488724
Provider Type
Individual
Full Name
Kelly, Amanda Rose
Credential
PA-C

Gender
Female
Sole Proprietor
Yes
Enumeration Date
4/7/2025
Last Updated
4/7/2025

Contact Information

Practice Location

175 Fore River Pkwy, Portland, ME 04102-2779

(207) 879-3000

Unlisted Fax

Mailing Location

175 Corral Ct, Roswell, GA 30076-1055

(470) 334-5105

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Amanda Rose Kelly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Bessey, Kristie L

Fisher, Patrick William

Seaman, Mary

Roth, Charles J.

Wallace, Chase E

Niland, Lori A

Sousa, Sydney Marie

Sheelar, Megan

Nelligan, William Woodward

Beaver, Eric A