Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly R Averett, PA-C

Individual provider Physician Assistant · NPI 1306198924

Kelly R Averett, PA-C is a Physician Assistant in Salt Lake City, Utah. Qualified in 2012, 14 years ago. Practices with Mountainstar Specialty Services LLC, a 29-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
14
Licensed in
UT
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1200 E 3900 S Unit G175
Salt Lake City, UT 84124-1300
Phone: (801) 268-7405
Fax: (801) 268-7435
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 4850503-1206 (UT)

Record details

NPI number1306198924
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 5, 2012
Last updated in NPPESFebruary 20, 2025
Certification dateFebruary 20, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Mountainstar Specialty Services Llc — 29 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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