Provider Demographics
NPI:1184481905
Name:ANDERSON, KELLY (DNP, APRN-CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP, APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 MATLOCK RD STE 131
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-6702
Mailing Address - Country:US
Mailing Address - Phone:817-583-6570
Mailing Address - Fax:817-887-5629
Practice Address - Street 1:8021 MATLOCK RD STE 131
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-6702
Practice Address - Country:US
Practice Address - Phone:817-583-6570
Practice Address - Fax:817-887-5629
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily