Provider Demographics
NPI:1093987117
Name:JOHN, KELSY FRANCES (AUDIOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:KELSY
Middle Name:FRANCES
Last Name:JOHN
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:10740 N GESSNER RD STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1240
Practice Address - Country:US
Practice Address - Phone:281-897-0416
Practice Address - Fax:281-890-8908
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB166198OtherMEDICARE - GROUP ID
TX207563201Medicaid