Provider Demographics
NPI:1114673951
Name:IVY, KELLI EMELINE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:EMELINE
Last Name:IVY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:4370 MEDICAL ARTS DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1713
Practice Address - Country:US
Practice Address - Phone:972-537-4100
Practice Address - Fax:972-537-4104
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1068869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily