{"npi":"1821492067","type":"NPI-1","status":"active","name":{"display":"Kelly Boardman PA-C","other":[],"first":"KELLY","last":"BOARDMAN","middle":"ASHLEY","credential":"PA-C"},"specialty":{"primary_taxonomy":"363AM0700X","primary_taxonomy_description":"Medical Physician Assistant","slug":"medical-physician-assistant","schema_org_specialty":null,"all":[{"code":"363AM0700X","description":"Medical Physician Assistant","primary":true,"state":"VA","license":"0110004747"}]},"addresses":[{"purpose":"LOCATION","street_1":"19415 DEERFIELD AVE","city":"LEESBURG","state":"VA","postal_code":"201768452","country_code":"US","street_2":"SUITE 213","phone":"7037299220","fax":"7038583529"},{"purpose":"MAILING","street_1":"2623 PURITAN CT","city":"HERNDON","state":"VA","postal_code":"201712439","country_code":"US","phone":"4043262826"}],"license":{"state":"VA","number":"0110004747"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"1821492067","state":"VA","issuer":null},{"type_code":"05","label":"Medicaid","value":"30016805880001","state":"VA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20150127002073","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"VA","pac_id":"8325362122"}]},"enumeration_date":"2014-10-17","last_updated":"2024-03-06","_meta":{"source":"NPPES","snapshot_date":"2024-03-06","doc_url":"https://findmynpi.com/api"}}