LISA KELLY (PA-C) – Medical Physician Assistant, NPI 1801187158

LISA KELLY (PA-C) is a healthcare provider. based in Grapevine, Texas. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA05811 (TX). The NPI Number for LISA KELLY (PA-C) is 1801187158

Main info

Female
18 Years Of Experience
Accepts Medicare Assignment
Name
LISA KELLY (PA-C)
NPI
1801187158
Phone
Not provided
Address
925 WILDWOOD CIR
Enumeration Date
20 April 2011
Last Update Date
4 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2008 (18 years ago)
PAC ID
2567640139
Group Practice PAC ID
1355254210
Professional Enrollment ID
I20110629000832
Address ID
TX752461608DA4001XSTXX300

Contacts

Secure Messaging
lkelly221923@direct.sw.org
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness85
Years active:15State licenses:1Other namesUpdated within 12 months

8,491 PHYSICIAN ASSISTANT in TX

Provider Addresses for LISA KELLY (PA-C)

  • 925 WILDWOOD CIR

    GRAPEVINE, TX 760516275

    Phone:

    Type: Mailing

  • 2740 N HWY 360

    GRAND PRAIRIE, TX 750506403

    Phone: (972) 606-8300

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $19.

Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.

Last reported payment date: 2023-04-25 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($19).

Total Amount

$19

General + Research + Ownership

Payments

1

Total payment records

General Amount

$19

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-04-25

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
GlaxoSmithKline, LLC.$19
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-06-29

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110629000832IPhysician AssistantTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
36415Insertion of needle into vein for collection of blood sample1211$0
View full utilization report →

Insurance plans in this area (ZIP 76051)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1355254210View full group profile
NameSpecialtyState
Radiation OncologyTX
Nurse PractitionerTX
Internal MedicineTX
-TX
-TX
Clinical Social WorkerTX
-TX
Nurse PractitionerTX
Orthopedic SurgeryTX
Clinical PsychologistTX

Reviews

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Frequently asked questions

Does LISA KELLY (PA-C) have a public NPI I can cite?
Public records show LISA KELLY (PA-C) under NPI 1801187158.
Is LISA KELLY (PA-C)'s NPI status active today?
Active status means LISA KELLY (PA-C)'s NPI record is not deactivated in the public file.
What type of care does LISA KELLY (PA-C) provide?
LISA KELLY (PA-C)'s profile centers on Medical Physician Assistant. Clinical services aligned with this taxonomy classification.
Is LISA KELLY (PA-C) tied to Grapevine, Texas?
If you are local to Grapevine, Texas, LISA KELLY (PA-C) may be relevant to your search.
Why is information missing for LISA KELLY (PA-C)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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