Provider Demographics
NPI:1417204868
Name:KELLY, MARGUERITE JANE (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:JANE
Last Name:KELLY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4730
Mailing Address - Country:US
Mailing Address - Phone:512-788-2350
Mailing Address - Fax:
Practice Address - Street 1:2301 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4730
Practice Address - Country:US
Practice Address - Phone:512-788-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN