Provider Demographics
NPI:1023623147
Name:KELLY, ARIELLE LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:LAUREN
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3004
Mailing Address - Country:US
Mailing Address - Phone:832-325-7288
Mailing Address - Fax:713-383-1464
Practice Address - Street 1:7400 FANNIN ST STE 855
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1951
Practice Address - Country:US
Practice Address - Phone:713-796-9466
Practice Address - Fax:713-796-9467
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA14018OtherTEXAS MEDICAL BOARD
TXPA14018OtherTEXAS MEDICAL BOARD
TX8PQ833OtherBCBS - XCITE SURGICAL
TX8PX966OtherBCBS - US MSO
TX8PQ830OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8PQ963OtherBCBS - BLUE STAR SURGICAL