Provider Demographics
NPI:1346347978
Name:KELLEY, JANICE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:CRINER
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 90639
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0639
Mailing Address - Country:US
Mailing Address - Phone:281-970-6089
Mailing Address - Fax:281-970-6105
Practice Address - Street 1:13323 DOTSON RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4303
Practice Address - Country:US
Practice Address - Phone:281-970-6089
Practice Address - Fax:281-970-6105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45D1015567OtherCLIA WAIVER
TX8J5580OtherBCBS PROVIDER NUMBER
TXC17776Medicare UPIN
TX8J5580OtherBCBS PROVIDER NUMBER