Provider Demographics
NPI:1689133456
Name:PADGETT, KELLY BROOKE (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:BROOKE
Last Name:PADGETT
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:TOOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11527 KINGS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-6527
Mailing Address - Country:US
Mailing Address - Phone:281-799-8243
Mailing Address - Fax:
Practice Address - Street 1:8608 N HIGHWAY 146 STE 600
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-7506
Practice Address - Country:US
Practice Address - Phone:832-556-6936
Practice Address - Fax:281-428-7035
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141060363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health