Provider Demographics
NPI:1225005531
Name:KELLEY, JANET L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847176
Mailing Address - Street 2:SUITE 5007
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7176
Mailing Address - Country:US
Mailing Address - Phone:903-237-1800
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:1111 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5537
Practice Address - Country:US
Practice Address - Phone:903-753-7658
Practice Address - Fax:903-236-0385
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7446207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168124905Medicaid
TX168124905Medicaid
TXTXB147932Medicare PIN