Provider Demographics
NPI:1124363460
Name:TRIPPLEHORN, KELLY (ACNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRIPPLEHORN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 W MAGNOLIA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8517
Mailing Address - Country:US
Mailing Address - Phone:817-870-7300
Mailing Address - Fax:817-927-0184
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-927-0184
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756385363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care