Provider Demographics
NPI:1801194634
Name:ZENTMEYER, KELLY LABADIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LABADIE
Last Name:ZENTMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 CLARK ST APT 717
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2409
Mailing Address - Country:US
Mailing Address - Phone:512-680-0428
Mailing Address - Fax:
Practice Address - Street 1:6120 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2601
Practice Address - Country:US
Practice Address - Phone:512-680-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant