Provider Demographics
NPI:1669644597
Name:HRANICKY, KELLY DEAN (LVN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DEAN
Last Name:HRANICKY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SOUTH RIEDEL
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-2024
Mailing Address - Country:US
Mailing Address - Phone:361-564-4106
Mailing Address - Fax:361-564-4127
Practice Address - Street 1:341 S REIDEL
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-2024
Practice Address - Country:US
Practice Address - Phone:361-564-4106
Practice Address - Fax:361-564-4163
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX088474164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016363Medicaid
TX005750701Medicaid