Provider Demographics
NPI:1598480170
Name:KELLY, LINDSEY FARRELL
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:FARRELL
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 NITA PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-8991
Mailing Address - Country:US
Mailing Address - Phone:972-463-7568
Mailing Address - Fax:
Practice Address - Street 1:5201 NITA PEARSON DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-8991
Practice Address - Country:US
Practice Address - Phone:972-463-7568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104252OtherASHA