Provider Demographics
NPI:1992825319
Name:MCCONNELL, KELLY DOBBS (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DOBBS
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7980 ANCHOR DR
Mailing Address - Street 2:SUITE 300-B
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8266
Mailing Address - Country:US
Mailing Address - Phone:409-727-4327
Mailing Address - Fax:409-727-5176
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:SUITE 300-B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-727-4327
Practice Address - Fax:409-727-5176
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51113231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3833Medicare PIN