Provider Demographics
NPI:1447568589
Name:LINLEY, KELLY L (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:LINLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 BENTON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3103
Mailing Address - Country:US
Mailing Address - Phone:806-935-1900
Mailing Address - Fax:806-934-3343
Practice Address - Street 1:2707 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2535
Practice Address - Country:US
Practice Address - Phone:806-935-1900
Practice Address - Fax:806-934-3343
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283242003Medicaid
TX283242003Medicaid
TX383883YMVRMedicare Oscar/Certification