Provider Demographics
NPI:1629567896
Name:NUNEMAKER, KELLY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:NUNEMAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9410 DUGAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1869
Mailing Address - Country:US
Mailing Address - Phone:210-680-8081
Mailing Address - Fax:210-680-3179
Practice Address - Street 1:5107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4801
Practice Address - Country:US
Practice Address - Phone:210-615-5541
Practice Address - Fax:210-615-1666
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP137130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP137130OtherTEXAS NURSING BOARD