Provider Demographics
NPI:1386001295
Name:KELLUM, CARMISHA (APRN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:CARMISHA
Middle Name:
Last Name:KELLUM
Suffix:
Gender:F
Credentials: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 1:25319 HOLTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1434
Mailing Address - Country:US
Mailing Address - Phone:832-620-6988
Mailing Address - Fax:
Practice Address - Street 1:1100 MERRILL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-6009
Practice Address - Country:US
Practice Address - Phone:713-864-7614
Practice Address - Fax:713-864-9004
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX769783363LF0000X
TXAP128781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily