Provider Demographics
NPI:1558357632
Name:THURMAN, KELLI YVETTE (NP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:YVETTE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:YVETTE
Other - Last Name:OSWALT/SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6913
Mailing Address - Country:US
Mailing Address - Phone:817-848-2708
Mailing Address - Fax:817-848-4579
Practice Address - Street 1:1600 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-848-2708
Practice Address - Fax:817-848-4579
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518078363L00000X, 363LC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041504401Medicaid
TX360649YKPWMedicare PIN
TX041504401Medicaid
TX82N725Medicare PIN