Provider Demographics
NPI:1043803703
Name:KELLY, BYRON (RN, LNFA)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:RN, LNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-2348
Mailing Address - Country:US
Mailing Address - Phone:832-428-5542
Mailing Address - Fax:
Practice Address - Street 1:340 N SAM HOUSTON PKWY E STE 231
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3321
Practice Address - Country:US
Practice Address - Phone:832-428-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9630542163W00000X, 163WC1500X, 163WN1003X, 163WW0101X, 163WL0100X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WP1700XNursing Service ProvidersRegistered NursePerinatal