Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kellie Lynn Dominessy, PA-C, MMS, ATC

Individual provider Physician Assistant · NPI 1932403383

Kellie Lynn Dominessy, PA-C, MMS, ATC is a Physician Assistant in Fort Lauderdale, Florida. Licensed in Florida. Registered with an NPI since 2010.

Licensed in
FL
In the registry since
2010
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

2307 W Broward Blvd Ste 200
Fort Lauderdale, FL 33312-1417
Phone: (954) 792-1010
Fax: (954) 792-1199
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA9105661 (FL)
Physician Assistant Taxonomy 363A00000X · Licence PA9105661 (FL)

Record details

NPI number1932403383
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C , MMS , ATC
Sole proprietorNo
NPI enumeratedDecember 28, 2010
Last updated in NPPESMarch 28, 2016

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