Provider Demographics
NPI:1134895790
Name:KELLY, TAMIA (PHLEBOTOMY TECHNICIA)
Entity type:Individual
Prefix:MS
First Name:TAMIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECHNICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 WESTPARK DR STE 149
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7417
Mailing Address - Country:US
Mailing Address - Phone:713-670-8189
Mailing Address - Fax:
Practice Address - Street 1:6220 WESTPARK DR STE 149
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7417
Practice Address - Country:US
Practice Address - Phone:713-670-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25-CPT126246R00000X, 246RP1900X
TX21-56670246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Single Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty