Provider Demographics
NPI:1134717127
Name:KELLY, ALEXANDREA CATHERINE
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:CATHERINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDREA
Other - Middle Name:CATHERINE
Other - Last Name:BILLIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE STE 352
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1270
Mailing Address - Country:US
Mailing Address - Phone:214-943-2249
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE STE 352
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1270
Practice Address - Country:US
Practice Address - Phone:214-943-2249
Practice Address - Fax:214-943-8213
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX861329163W00000X
TX1024508363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care