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

Mr. Jonathan D Kelly, PAC

Individual provider Medical Physician Assistant · NPI 1053529446

Mr. Jonathan D Kelly, PAC is a Physician Assistant in Farmington, New Mexico. Qualified in 2002, 24 years ago. Practices with San Juan Medical Group PC, an 11-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New Mexico.

Years since qualifying
24
Licensed in
NM
In the registry since
2007
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

622 W Maple St Ste B
Farmington, NM 87401-6589
Phone: (505) 327-4867
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 102 Llano St, Aztec, NM 87410-2172 — (505) 334-9441

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA054 (NM)

Record details

NPI number1053529446
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedMay 18, 2007
Last updated in NPPESJanuary 12, 2023
Certification dateJanuary 12, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice San Juan Medical Group Pc — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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