Provider Demographics
NPI:1376997023
Name:ABBEE, KELLIE (NP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:ABBEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E SOUTHLAKE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6350
Mailing Address - Country:US
Mailing Address - Phone:817-873-0590
Mailing Address - Fax:817-873-0591
Practice Address - Street 1:1100 E SOUTHLAKE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6350
Practice Address - Country:US
Practice Address - Phone:817-873-0590
Practice Address - Fax:817-873-0591
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130839OtherLICENSE