Provider Demographics
NPI:1114421377
Name:GARCIA, KELLI ANN (LVN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6515 SONORA DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7232
Mailing Address - Country:US
Mailing Address - Phone:803-800-0701
Mailing Address - Fax:
Practice Address - Street 1:6515 SONORA DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7232
Practice Address - Country:US
Practice Address - Phone:803-800-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334708164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse