Provider Demographics
NPI:1912390352
Name:TOWNSEND, KELLY ANNE (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8668 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8216
Mailing Address - Country:US
Mailing Address - Phone:214-349-4909
Mailing Address - Fax:214-349-4973
Practice Address - Street 1:8668 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8216
Practice Address - Country:US
Practice Address - Phone:214-349-4909
Practice Address - Fax:214-349-4973
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily