Provider Demographics
NPI:1679028955
Name:DURON, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DURON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:DURON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:252 TREELINE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7838
Mailing Address - Country:US
Mailing Address - Phone:713-501-3225
Mailing Address - Fax:
Practice Address - Street 1:1016 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2902
Practice Address - Country:US
Practice Address - Phone:573-218-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37258103TC0700X
MO2014004443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical