Provider Demographics
NPI:1326432295
Name:KELLY R. WILL, M.D., P.A.
Entity Type:Organization
Organization Name:KELLY R. WILL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-777-6101
Mailing Address - Street 1:7865 FIREFALL WAY APT 3538
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-7345
Mailing Address - Country:US
Mailing Address - Phone:214-507-0188
Mailing Address - Fax:
Practice Address - Street 1:7515 GREENVILLE AVE STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3849
Practice Address - Country:US
Practice Address - Phone:972-777-6101
Practice Address - Fax:972-833-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty