Provider Demographics
NPI: | 1659919389 |
---|---|
Name: | LENHART, KELLY NICOLE (AGACNP-BC) |
Entity Type: | Individual |
Prefix: | |
First Name: | KELLY |
Middle Name: | NICOLE |
Last Name: | LENHART |
Suffix: | |
Gender: | F |
Credentials: | AGACNP-BC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2725 MATLOCK RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ARLINGTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76015-2529 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2725 MATLOCK RD |
Practice Address - Street 2: | |
Practice Address - City: | ARLINGTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76015-2529 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-417-4027 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-12-12 |
Last Update Date: | 2022-10-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | AP142637 | 363LA2100X, 363L00000X |
IL | 209021918 | 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |