Provider Demographics
NPI:1366033474
Name:KEARNS, KEELY ALLISON (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KEELY
Middle Name:ALLISON
Last Name:KEARNS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4501
Mailing Address - Country:US
Mailing Address - Phone:817-715-2822
Mailing Address - Fax:
Practice Address - Street 1:2028 E BEN WHITE BLVD STE 240-4949
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6966
Practice Address - Country:US
Practice Address - Phone:512-655-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045862363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1045862OtherTEXAS BOARD OF NURSING