Provider Demographics
NPI:1417523036
Name:GARZA, KELLI RENAE (MSN, APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENAE
Last Name:GARZA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SE LOOP 410 STE 127A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-4933
Mailing Address - Country:US
Mailing Address - Phone:210-447-7961
Mailing Address - Fax:210-442-8973
Practice Address - Street 1:2000 SE LOOP 410 STE 127A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-4933
Practice Address - Country:US
Practice Address - Phone:210-447-7961
Practice Address - Fax:210-442-8973
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty