Provider Demographics
NPI:1003027533
Name:STARKEY, KELLY C (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:STARKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:815 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-321-0404
Practice Address - Fax:469-522-6889
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ17252085R0202X, 2085R0202X
LAMD.2022002085R0202X
IL036-1305312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J062Medicare PIN
LA07880Medicaid