Provider Demographics
NPI:1114352416
Name:SPRINGER, KELLY
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 48TH ST APT 27
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-1435
Mailing Address - Country:US
Mailing Address - Phone:806-995-5046
Mailing Address - Fax:
Practice Address - Street 1:5602 48TH ST APT 27
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-1435
Practice Address - Country:US
Practice Address - Phone:806-995-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008356251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management