Provider Demographics
NPI:1821288465
Name:MONTIVILLE, KELLY HORTON (MD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:HORTON
Last Name:MONTIVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:MELISSA
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:602 HIGH TECH DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626
Mailing Address - Country:US
Mailing Address - Phone:512-863-8600
Mailing Address - Fax:512-863-8641
Practice Address - Street 1:602 HIGH TECH DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:512-863-8600
Practice Address - Fax:512-863-8641
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0995207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology