Provider Demographics
NPI:1154665990
Name:BOND, KELLIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:WEBB-CASERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP STUDENT
Mailing Address - Street 1:12611 TERRACE HOLW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2212
Mailing Address - Country:US
Mailing Address - Phone:707-410-6453
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5638
Practice Address - Country:US
Practice Address - Phone:210-808-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0001406-C-NP363LP0808X
KS87631390200000X
TX730340390200000X
NMCNP-02720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program