Provider Demographics
NPI:1124386941
Name:KELLY J FOX LLC
Entity Type:Organization
Organization Name:KELLY J FOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:940-387-5800
Mailing Address - Street 1:2412 OLD NORTH RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1548
Mailing Address - Country:US
Mailing Address - Phone:940-387-5800
Mailing Address - Fax:940-387-5806
Practice Address - Street 1:2412 OLD NORTH RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1548
Practice Address - Country:US
Practice Address - Phone:940-387-5800
Practice Address - Fax:940-387-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty