Provider Demographics
NPI:1861842908
Name:KELLY, PATRICIA (APRN, CNS, AGN-BC, A)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:APRN, CNS, AGN-BC, A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9649 COVEMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1819
Mailing Address - Country:US
Mailing Address - Phone:214-345-6307
Mailing Address - Fax:
Practice Address - Street 1:9649 COVEMEADOW DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1819
Practice Address - Country:US
Practice Address - Phone:214-345-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX428918163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology