Provider Demographics
NPI:1598116238
Name:KELLEY, BRITANY LYN (APN)
Entity Type:Individual
Prefix:
First Name:BRITANY
Middle Name:LYN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:210-224-1771
Mailing Address - Fax:210-229-9138
Practice Address - Street 1:124 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1202
Practice Address - Country:US
Practice Address - Phone:210-224-1771
Practice Address - Fax:210-229-9138
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP131099OtherNURSE PRACTITIONER