Provider Demographics
NPI:1376972943
Name:KELLY, KEVIN JOSEPH (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:KELLY
Suffix:
Gender:M
Credentials:MSN, APRN, 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:PO DRAWER F
Mailing Address - Street 2:
Mailing Address - City:ROTAN
Mailing Address - State:TX
Mailing Address - Zip Code:79546
Mailing Address - Country:US
Mailing Address - Phone:325-735-2256
Mailing Address - Fax:
Practice Address - Street 1:774 STATE HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:ROTAN
Practice Address - State:TX
Practice Address - Zip Code:79546-6918
Practice Address - Country:US
Practice Address - Phone:325-735-2256
Practice Address - Fax:325-735-3070
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily